Medical errors have become an accepted if unfortunate part of medical care, but physicians may greatly underestimate how much they contribute to the problem. "The average clinician is making a lot of mistakes that they are unaware of," says Dr Art Papier, a dermatologist and medical informatics specialist. How many doctors fall into this category? All but the "master diagnosticians," who represent less than 1% of practicing clinicians, he says. That would mean that 99% of doctors regularly make errors that they never realize they made. "We don't really understand how many mistakes we're making," he says. Papier points to analyses of malpractice claims[1] that show diagnostic errors are the largest cause of lawsuits, not bad outcomes of surgeries or baby deliveries as many people believe. And many of the missed diagnoses that lead to lawsuits are for common diseases such as cancer. "Patients come in with common things," he says, "but we are frequently fooled by variant presentations of common diagnoses." When working up a patient with chronic headache, for example, a clinician might consider all the usual pathologic causes but fail to uncover the fact that the patient was exposed to carbon monoxide at work, Papier says. "We ask questions about what we know; we don't ask about what we don't know." Human Intelligence Plus Artificial Intelligence Fortunately, new decision support tools are available that can help streamline the diagnostic process and help clinicians more reliably get to the right answer, much like guidance systems routinely help drivers find addresses they never visited before. Some of these tools employ artificial intelligence (AI), which are techniques that enable computers to mimic human behavior, or they use machine learning, a subset of AI that uses statistical methods to enable machines to improve as they solve more problems. The US Food and Drug Administration (FDA) has approved three AI-based tools this year for use in the clinic. The LVO Stroke Platform flags signs of stroke on computed tomography scans. The IDx-DR device can be used by primary care clinicians to screen for diabetic retinopathy. The third device, OsteoDetect, is used to diagnosis wrist fractures in adults. Other tools are not regulated by the FDA, based on the level of decision-making still left to the clinician. Some are apps available for download to a smartphone, including one developed by the Centers for Disease Control and Prevention for coagulation and bleeding disorders, called the PTT Advisor. Papier, who frequently speaks about the role of AI in the future of medicine, is partial to an app produced by his company, VisualDx, which was highlighted by Apple CEO Tim Cook. The app uses Apple software called Core ML, which enables machine learning locally on the device itself rather than sending patient information out into the world, which would violate HIPAA regulations. Source
