Although clinicians are often unsure of diagnoses, they tend to underestimate the rate of diagnostic errors and frequently fail to recognize how diagnostic testing affects patients, a study published online May 15 in the Journal of General Internal Medicine shows. "Perhaps the most striking finding was that physicians often feel unsure of diagnoses, regardless of setting or experience," write Thilan P. Wijesekera, MD, MHS, from Yale University School of Medicine, New Haven, Connecticut, and colleagues. In an interview with Medscape Medical News, David E. Newman-Toker, MD, PhD, professor of neurology, ophthalmology, and otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, emphasized that diagnostic uncertainty is a fact of life in medicine and that diagnostic errors cannot be completely avoided. "Nevertheless," he said, "it is critically important that physicians not use this reality as an excuse to be nihilistic about improving diagnosis. There is ample evidence that we could (and should) be doing better than we are today in making accurate and timely diagnoses." Diagnosis is one of the most important tasks performed by clinicians, and the "concept of diagnostic uncertainty has gained increasing attention as providers navigate the challenges in medical decision making," the authors say. In 2015, the National Academy of Medicine (NAM) published its landmark report, Improving Diagnosis in Health Care. In that report, diagnostic errors were identified as common problems relating to patient safety. With this in mind, Wijesekera and colleagues conducted a survey of residents (n = 196) and attending physicians (n = 70) from nine Connecticut internal medicine training programs to gain insight into how clinicians make diagnoses and deal with diagnostic error. The NAM report highlighted five key factors that have a negative effect on physicians' ability to make correct diagnoses. Respondents in the current study identified time constraints (n = 178; 70%) during the diagnostic process as the factor that most hindered their ability to make a diagnosis. Almost half of physicians in both inpatient (49%) and outpatient (41%) settings indicated feeling diagnostic uncertainty every day. Despite the challenges of the diagnostic process, most respondents (inpatient, 67%; outpatient, 61%) reported that they did not consistently think about the advantages and risks of diagnostic testing for their patients. Also, despite the high rate of diagnostic uncertainty among clinician respondents, most believed that diagnostic errors were uncommon. The majority thought they occurred once a month or less frequently (inpatient, 54%; outpatient, 60%). This is in stark contrast with findings in the NAM report, which indicated that diagnostic errors arise in 10% to 15% of patient encounters, the authors of the current study note. Source
