Teamwork may be one way to help reduce the incidence of diagnostic mistakes, in which patients' conditions are missed, delayed or diagnosed incorrectly, a study suggests. When two doctors worked together, their confidence in a diagnosis was boosted and their determination was more accurate.
One out of every 20 U.S. adults could be misdiagnosed during outpatient visits, and about half of those errors could prove to be harmful, recent estimates find. Still, researchers say little is understood about the many factors—such as lapses in clinical judgment, time shortages or communication breakdowns—that lead to the mistakes.
German researchers, who published their findings in a research letter in this week's Journal of the American Medical Association, recruited 88 fourth-year medical students as volunteers and presented them with video showing simulated patient cases. After the presentation, the students were asked to quickly determine which of a total of 30 diagnostic tests should be ordered, and select one of 20 possible diagnoses from a list. Participants also had to rate on a scale of 1 (least confident) to 10 (most confident) how certain they were in their decisions. Twenty-eight of the students worked individually while the rest worked in pairs.
Those working in pairs took 2:02 minutes longer than individuals, but they were also more accurate in selecting a diagnosis (68 %) compared with those working individually (50%). Overall, pairs expressed more confidence in their decision than those working alone.
“Neither differences in knowledge nor in amount and relevance of acquired information explained the superior accuracy of the pairs,” the authors wrote. “Collaboration may have helped correct errors, fill knowledge gaps and counteract reasoning flaws,” they said.
Patient-safety leaders in the U.S. are anticipating an Institute of Medicine report this fall that's expected to raise a red flag on diagnosis errors and give advocates the fuel needed to focus resources on addressing this cause of patient harm. The shift in healthcare toward value-based care models could help put systems in place that makes the diagnostic process more reliable, experts say.
“Diagnosis is really a team effort,” said Dr. Gordon Schiff, a leading diagnostic error researcher who practices general internal medicine at Brigham and Women's Hospital in Boston. The patient, their caregiver and everyone who encounters the patient, from the nurses to the doctors, plays a role. The idea that diagnosis is “this heroic, lone ranger thing the doctor does with the doors closed in their office” is romantic and outdated, he told Modern Healthcare for a story published this week.
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