Does Time Pressure Have a Negative Effect on Diagnostic Accuracy?

Alqahtani, Dalal Abdullah; Rotgans, Jerome I.; Mamede, Sílvia; Al-Alwan, Ibrahim; Magzoub, M.; Altayeb, Fatheya M.; Mohamedani, Manahil A.; Schmidt, Henk G.

doi:10.1097/acm.0000000000001098

Cited by 44 publications

(32 citation statements)

References 29 publications

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“…We state this conclusion with some certainty because our study used a within-group design, excluding the possibility of confounding factors due to poor randomization. In addition, we have used the same methodology in similar studies, demonstrating that our procedures are sensitive to experimental manipulations of the kind attempted in this study (23,24). For instance, in a study on the negative influence of so called "difficult patients," using the same methods, we were able to demonstrate rather strong effects with similarly subtle differences in the descriptions of patients (17,18).…”

Section: Discussionmentioning

confidence: 62%

Do Poor Patients Suffer from Inaccurate Diagnoses More than Well-to-do Patients? A Randomized Control Trial

Alwan

Magzoub

Haqwi

et al. 2019

Preprint

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Background. Poor patients have greater morbidity and die up to ten years earlier than patients who have higher socio-economic status. These findings are often attributed to differences in life-style between groups. The present study aimed at investigating the extent to which physicians contribute to the effect by providing relative poorer care, perhaps resulting in relative neglect in terms of time spent with a poor patient and more inaccurate diagnoses. Methods. A randomised experiment with 45 internal medicine residents. Doctors diagnosed twelve written clinical vignettes that were exactly the same except for the description of the patients' socio-economic status. Each participant diagnosed four of the vignettes in a poor-patient version, four in a rich-patient version, and four in a version that did not contain socio-economic markers, in a balanced within-subjects incomplete block design. Main measurements were: diagnostic accuracy scores and time spent on diagnosis. Results. Mean diagnostic accuracy scores (range 0-1) did not significantly differ among the conditions of the experiment (for poor patients: 0.48; for rich patients: 0.52; for patients without socio-economic markers: 0.54; p > 0.05). While confronted with patients not presenting with socioeconomic background information, the participants spent significantly less time-to-diagnosis ((for poor patients: 168 seconds; for rich patients: 176 seconds; for patients without socio-economic markers: 151 seconds; p < 0.01), however due to the fact that the former vignettes were shorter.Conclusion. There is no reason to believe that physicians are prejudiced against poor patients and therefore treat them differently from rich patients or patients without discernible socio-economic background.

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Section: Discussionmentioning

confidence: 62%

Do Poor Patients Suffer from Inaccurate Diagnoses More than Well-to-do Patients? A Randomized Control Trial

Alwan

Magzoub

Haqwi

et al. 2019

Preprint

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“…Moreover, the present authors found that the negative effects of time pressure could extend to physicians’ diagnostic performance. Using clinical vignettes, we showed that senior internal medicine residents committed more diagnostic errors when they were put under time pressure compared with a control group . Although these results suggest that time constraints can reduce the quality of diagnosis, other studies did not show this effect, but instead suggested that quick processing does not necessarily lead to diagnostic error…”

Section: Introductionmentioning

confidence: 65%

Factors underlying suboptimal diagnostic performance in physicians under time pressure

et al. 2018

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CONTEXT Time pressure has been implicated in the suboptimal diagnostic performance of doctors and in increases in diagnostic errors. However, the reasons underlying these effects are not clear. The aim of this study was to investigate the influence of time pressure on physicians' diagnostic accuracy and to explore the mediating effects of perceived stress (emotional pathway) and number of plausible diagnostic hypotheses (cognitive pathway) on the proposed relationship.METHODS We conducted a randomised controlled experiment. A total of 75 senior internal medicine residents completed eight written clinical cases under conditions with (n = 40) or without (n = 35) time pressure. They were then asked to: (i) rate the overall stress experienced, and (ii) write down any alternative hypotheses they had thought of when diagnosing the cases. In a post hoc analysis, a mediation path analysis was performed to test the causal relationships between time pressure, perceived stress and number of alternative diagnoses. RESULTSParticipants who were under time pressure spent less time diagnosing the cases (85.54 seconds versus 181.81 seconds; p< 0.001) and had a lower mean diagnostic accuracy score (0.44 versus 0.53; p = 0.01). In addition, they reported more stress (5.80 versus 4.69; p = 0.01) and generated fewer plausible tentative hypotheses (0.37 versus 0.51; p = 0.01). Two path coefficients were found to be statistically significant; the first path coefficient referred to the relationship between time pressure and perceived stress (standardised b = 0.25, p = 0.029), and the second negative path coefficient referred to the relationship between time pressure and number of plausible alternative hypotheses (standardised b = À0.32, p< 0.01).CONCLUSIONS Time pressure adversely influences physicians' diagnostic accuracy by increasing their stress response and reducing the number of plausible hypotheses as mediators.

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“…A randomised controlled experiment by ALQahtani et al, for example, reported that internal medicine residents made on average 37% more diagnostic errors under time pressure than their peers in the control no-time-pressure group [22]. Similarly, in a Time pressures faced in general dental practice, therefore, may have a negative impact on the quality of care delivered.…”

Section: Discussionmentioning

confidence: 99%

“…Although dentists perceive time pressure as an important stressor which may potentially influence their clinical decisions [16,17], a systematic review of the dental literature identified no experimental studies that assessed the impact of stress or different stressors on dentists' performance [18]. In contrast, there is ample evidence from other medical domains showing that time pressure affects decision making and diagnostic accuracy of healthcare professionals as well as their psychomotor performance and procedural skills [19][20][21][22][23]. Whether time pressure has similar impact on dentists' performance, however, is an open and important question.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Impact of time pressure on dentists’ diagnostic performance

Plessas

Nasser

Hanoch

et al. 2019

Journal of Dentistry

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Objectives: Although stress is prevalent amongst dentists, there is a paucity of data on the impact of stressors on dentists' clinical performance. To address this gap in the literature, the aim of the present study was to explore the role of time pressure, representing one common stressor, on dentists' radiographic diagnostic performance. Methods: Forty dentists were randomised to examine and provide a radiographic report on two sets of radiographs (six bitewings in each set) under two conditions on a cross-over basis: time-pressure vs. no-time-pressure. The radiographic report of an experienced consultant was considered the gold standard against which participants diagnostic decisions were compared to calculate sensitivity and specificity. Participants rated their stress after each experimental condition using a 100 mm visual analogue scale (VAS). Results: The VAS scores for stress were significantly higher in the time pressure Conclusions: Time pressure negatively impacts one aspect of dentists' diagnostic performance, namely sensitivity (increased diagnostic errors and omissions of pathology), which can potentially affect patient safety and the quality of care delivered. However, time pressure was found to have less influence on diagnostic specificity. Clinical Significance: The present study demonstrated a significant deterioration of dentists' diagnostic performance (sensitivity) under time-pressure when examining bitewing radiographs. Diagnostic errors may put patient safety at risk, with patients potentially being harmed if pathology is missed. Such errors can have medicolegal implications on the dentists' practice.

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Does Time Pressure Have a Negative Effect on Diagnostic Accuracy?

Cited by 44 publications

References 29 publications

Do Poor Patients Suffer from Inaccurate Diagnoses More than Well-to-do Patients? A Randomized Control Trial

Do Poor Patients Suffer from Inaccurate Diagnoses More than Well-to-do Patients? A Randomized Control Trial

Factors underlying suboptimal diagnostic performance in physicians under time pressure

Impact of time pressure on dentists’ diagnostic performance

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