Physicians’ Diagnostic Accuracy, Confidence, and Resource Requests

Meyer, Ashley N. D.; Payne, Velma L.; Meeks, Derek W; Rao, Radha; Singh, Hardeep

doi:10.1001/jamainternmed.2013.10081

Cited by 202 publications

(152 citation statements)

References 22 publications

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“…Studies have shown that diagnostic accuracy and physician confidence do not necessarily match [10,11]. When doctors have more confidence in their diagnosis than is warranted, they "might not request the required additional resources to facilitate diagnosis when they most need it" [12]. While those additional resources might in some cases be consultation with another physician, in some cases patients may be able to offer resources such as details about the symptoms or the history that could be useful.…”

Section: Sources Of Diagnostic Errormentioning

confidence: 99%

Let patients help with diagnosis

Graedon

2014

Diagnosis

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Diagnostic errors are common and have seemed intractable for decades. Although time pressure is often cited as a contributor to this problem, overconfidence on the part of the diagnostician may also play a role. Successful strategies for reducing error in the diagnostic process should include patients and families in innovative ways. Changing the existing paradigm of patients responding passively to one of patients participating actively has the potential to assist in achieving greater diagnostic accuracy. Providers should welcome patients' online research into their symptoms, succinct summaries of their course of illness and questions about the differential diagnoses that might be applicable. Systematic methods for following up after the initial diagnosis are essential for verifying accuracy as well as providing excellent patient care.

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Section: Sources Of Diagnostic Errormentioning

confidence: 99%

Let patients help with diagnosis

Graedon

2014

Diagnosis

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“…There is evidence that confidence and accuracy are at odds in medicine. For example, radiologists who performed less well were highly confident that they were accurate [20]; a survey of 100 internal medicine physicians found only a very small difference in confidence in diagnostic accuracy between very difficult and simple clinical cases, whereas there was a large difference in actual diagnostic accuracy [16], and surgical residents were confident they would recognize different distal radius fractures 68% of the time while actually identifying only 33% correctly [18]. Overconfidence bias can lead to other biases such as the availability heuristic (considering only the first thing that comes to mind) and confirmation bias, where a person notices only the things that agree with his or her point of view and is less attentive to support for alternative viewpoints [15].…”

Section: Discussionmentioning

confidence: 99%

Do Orthopaedic Surgeons Acknowledge Uncertainty?

Teunis

Janssen

Guitton

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Much of the decision-making in orthopaedics rests on uncertain evidence. Uncertainty is therefore part of our normal daily practice, and yet physician uncertainty regarding treatment could diminish patients' health. It is not known if physician uncertainty is a function of the evidence alone or if other factors are involved. With added experience, uncertainty could be expected to diminish, but perhaps more influential are things like physician confidence, belief in the veracity of what is published, and even one's religious beliefs. In addition, it is plausible that the kind of practice a physician works in can affect the experience of uncertainty. Practicing physicians may not be immediately aware of these effects on how uncertainty is experienced in their clinical decisionmaking. Questions/purposes We asked: (1) Does uncertainty and overconfidence bias decrease with years of practice? (2) What sociodemographic factors are independently associated with less recognition of uncertainty, in particular belief in God or other deity or deities, and how is atheism associated with recognition of uncertainty? (3) Do confidence bias (confidence that one's skill is greater than it actually is), degree of trust in the orthopaedic evidence, and degree of statistical sophistication correlate independently with recognition of uncertainty? Methods We created a survey to establish an overall recognition of uncertainty score (four questions), trust in the orthopaedic evidence base (four questions), confidence bias (three questions), and statistical understanding (six questions). Seven hundred six members of the Science of Variation Group, a collaboration that aims to study variation in the definition and treatment of human illness, were approached to complete our survey. This group represents One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, an amount of less than USD 10,000 during the study period from Wright Medical (Memphis, TN, USA); an amount less than USD 10,000 from Skeletal Dynamics (Miami, FL, USA); an amount less than USD 10,000 from Biomet (Warsaw, IN, USA); an amount less than USD 10,000 from AO North America (Paoli, PA, USA); and an amount less than USD 10,000 from AO International (Dubendorf, Switzerland Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® mainly orthopaedic surgeons specializing in trauma or hand and wrist surgery, practicing in Europe and North America, of whom the majority is involved in teaching. Approximately half of the group has more than 10 years of experience. Two hundred forty-two (34%) members completed the survey. We found no differences between responders and nonresponders. Each survey item measured its own trait better than any of the other traits. Recognition of uncertainty (0.70) and confidence bias (0.75) had relatively high Cronbach alpha levels, meaning that the questions making up these traits are closely related and probably measure the ...

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“…The cognitive psychology literature supports the sequential inclusion of non-analytic and analytic reasoning in all cases, even straightforward ones. 8,9 In this example, it took the blood culture results to lift the discussant's anchor, which was initially fixed on a viral syndrome. Analytic reasoning can serve as a cross-check (e.g., is the diagnosis adequate?…”

Section: Discussionmentioning

confidence: 99%