Misleading one detail: A preventable mode of diagnostic error?

Shahar Arzy*, Mayer Brezis, Salim Khoury, Steven R. Simon, Tamir Ben-Hur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Rationale, aims and objectives Despite advances in our understanding of cognitive biases in clinical practice, little is known about correction or prevention of diagnostic errors. The presence of a single misleading detail may lead clinicians down a cognitive and actual path toward an incorrect diagnosis. Methods In a large teaching hospital, we surveyed 51 attending doctors in internal medicine, presenting each with 10 clinical vignettes and soliciting their diagnosis of the condition leading to the presentation. Each of the 10 clinical cases included a single misleading detail. Results This survey elicited a wrong diagnosis in 90% of cases, which was reduced to 30% when omitting the misleading detail from the vignette. Diagnostic accuracy did not improve by warning doctors about potentially misleading information. Asking doctors to identify a leading diagnostic detail and then to formulate an alternative diagnosis after omission of the detail, significantly reduced diagnostic error rate by nearly 50%. Conclusion Systematic re-examination of leading diagnostic clues may help to reduce errors in diagnosis.

Original languageAmerican English
Pages (from-to)804-806
Number of pages3
JournalJournal of Evaluation in Clinical Practice
Volume15
Issue number5
DOIs
StatePublished - Oct 2009
Externally publishedYes

Keywords

  • Clinical decision making
  • Clinical errors
  • Cognitive disposition

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