Posted on Oct 14, 2019, 8 p.m.
In a recent Medscape poll 1 in 6 doctors say that they make diagnostic errors of some sort every day, and some jokingly suggest that is only because the other 5 are lying, and others joking suggest they don’t make them every day because of the loophole that they don’t work weekends.
However, joking aside, this number varies by speciality; pediatricians were less likely to admit to making diagnostic errors every day with 11% saying they did, emergency doctors were more likely at 26%, family medicine physicians were at 18%, general practice physicians 22%, and internal medicine physicians were at 15%. In all three categories nurses, advanced practice registered nurses and physician assistants answered similarly with 17% saying that they made diagnostic errors daily.
Medscape reported poll results from a study published in the Journal of General Internal Medicine which suggested that physicians tend to underestimate how often they make diagnostic errors; repondants included 633 physicians and 118 nurses for a total of 751 participants.
Johns Hopkins University of Medicine also conducted a survey of physicians at 9 Connecticut internal medicine training programs to assess thoughts regarding diagnostic error and uncertainty; most believed errors to be uncommon despite half reporting they felt diagnostic uncertainty every day.
Previous figures published estimate that diagnostic errors occur in 10-15% of all patient encounters. It is important to make a distinction between uncertainty and incorrect diagnoses, of which uncertainty is part of the basis for a referral to a specialist.
According to the polls NPs and PAs report higher rates of diagnostic uncertainty than physicians, and the rates were similar for both genders. NPs/PAs reported having daily uncertainty at 64%, once a week at 21%, a few times a month at 9% once a month at 5%, and never at 0%. Physicians reported having daily uncertainty at 52%, once a week at 20%, a few times a month at 13%, once a month at 14%, and never at 0%.
Both NPs/PAs and physicians agreed that the top 3 reasons diagnostic errors occur is due to 1) lack of feedback on diagnostic error being listed by 38% of physicians and 44% of NPs/PAs; 2) time constraints was listed by 37% of the physicians and 47% of the NPs/PAs; and 3) a culture that discourages disclosure of errors being list by 27% of the physicians and 33% of the NPs/PAs.
Keep in mind that it is hard to practice medicine properly in the 15 minute window, especially by clinicians with patients that they have nearly zero history with, and some illnesses take time to reveal themselves as well. It’s also no secret that many errors can occur due to patients not being completely honest when it comes to their condition making it even harder to find the reason for medical help, and patients not taking the advice seriously often results in them getting even worse. How can errors be impossible as medicine may know a lot, but it doesn’t know everything.
What is important to remember is that those that admit to making mistakes more often are typically driven to correct their mistakes and improve their practice.
To quote a wise person: “Sound medical judgement is the resolution of uncertainty. Never consider a diagnosis as final, stay ready to change your mind with any new knowledge. This is what gives value to continuity of care.”
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This article is not intended to provide medical diagnosis, advice, treatment, or endorsement.