April 28, 2008

Eta Berner.

• Medical diagnoses sometimes wrong

• Physician overconfidence may be contributing factor

• Conference on diagnostic errors set for May

Birmingham, Ala., - How frequently do doctors misdiagnose patients? While research has demonstrated that the great majority of medical diagnoses are correct, the answer is probably higher than patients expect and certainly higher than doctors realize. In a Supplement to the May issue of The American Journal of Medicine, a collection of articles and commentaries sheds light on the causes underlying misdiagnoses and demonstrates a nontrivial rate of diagnostic error that ranges from less than five percent in the perceptual specialties (pathology, radiology, dermatology) up to 10 percent to 15 percent in many other fields.

Guest Editors Eta S. Berner, Ed.D. professor of health administration in the School of Health Professions at UAB (University of Alabama at Birmingham) and Mark L. Graber, MD, FACP Veterans Affairs Medical Center, Northport, NY and Department of Medicine, SUNY Stony Book oversaw the development and compilation of these papers. The lead paper by Berner and Graber was an extensive literature review concerning teaching, learning, reasoning and decision making as they relate to diagnostic error and overconfidence and developed a framework for strategies to address the problem.  

"The sensitive issue of diagnostic error is rarely discussed and has been understudied," said Berner. "The papers in this volume confirm the extent of diagnostic errors and suggest improvement will best come by developing systems to provide physicians with better feedback on their own errors. Given that physicians overall are highly dedicated and well-intentioned, we believe that if they were more aware of these factors and their own predisposition to error, they would adopt behaviors and attitudes that would help decrease the likelihood of diagnostic error."

Graber, himself a physician, noted that when directly questioned, many clinicians find it inconceivable that their own error rate could be as high as the literature demonstrates. They acknowledge that diagnostic error exists, but believe the rate is very low, and that any errors are made by others who are less skillful or less careful.

Papers in the supplement include reviews of clinical reasoning to better understand the processes underlying overconfidence; studies that highlight gaps in knowledge about the nature of diagnostic problems; an examination of the barriers to adequate feedback and follow-up in the real world of clinical practice; and recommendations to help reduce diagnostic error.

"In my view, diagnostic error will be reduced only if physicians have a more realistic understanding of the amount of diagnostic errors they personally make," summarizes Paul Mongerson, who created a foundation to promote computer-based and other strategies to reduce diagnostic errors. "I believe that the accuracy of diagnosis can be best improved by informing physicians of the extent of their own errors and urging them to personally take steps to reduce their own errors."

The Supplement appears in The American Journal of Medicine, Volume 121, Issue 5A (May 2008) published by Elsevier. This supplement was sponsored by the Paul Mongerson Foundation through the Raymond James Charitable Endowment Fund. Many of the ideas expressed here emerged from discussions at a meeting among the authors in Naples, Florida, in December 2006 that was sponsored by the University of Alabama at Birmingham with support from the Paul Mongerson Foundation. 

Berner and Graber will be co-directing the first national conference focusing on diagnostic errors in medicine, May 31- June 1, 2008 in Phoenix, AZ. The conference is co-sponsored by the Agency for Healthcare Research and Quality and the American Medical Informatics Association. The program includes leaders in this field including the authors of the papers in this supplement.