Doctors working in teams may make more accurate diagnoses than doctors working alone, a recent study suggests.
researchers recruited 88 fourth year medical student volunteers and
showed them videos of simulated patient cases. They then asked the
volunteers to select one of 20 possible diagnoses, and order from a menu
of 30 possible tests. Twenty eight of the students worked individually
and the remaining 60 worked in pairs. Those working in pairs were 18
percent more accurate in their diagnoses. The study also found that pairs were more likely to differ in confidence about the diagnosis when the diagnosis was incorrect.
researchers said superior accuracy of the pairs could not be explained
by differences in knowledge or relevant information. "Collaboration may
have helped correct errors, fill knowledge gaps and counteract reasoning
flaws," researcher Dr. Wolf E. Hautz and colleagues said. The findings
appeared in a research letter in the Journal of the American Medical Association.
A story by Sabriya Rice in Modernhealthcare.com
reports that as many as one out of 20 adults in the U.S. may be
misdiagnosed in outpatient visits, and about half of those errors could
hospitals have developed systems for monitoring healthcare acquired
infections and surgical errors and other patient safety issues, experts
say systems for tracking diagnostic mistakes barely exist and causes of
diagnostic error have not been thoroughly researched. The 1999
Institute of Medicine Report "To Err is Human"
brought medical error into public consciousness but did not focus on
diagnostic error. The IOM report due this fall is expected to probe diagnostic error. Complicating the issue, Rice writes, is that there is no universally accepted definition of a diagnostic error.
According to a 2014 study by CRICO Strategies,
a Cambridge, Mass.-based risk-management group, about 20 percent of
23,527 medical malpractice cases filed between 2008 and 2012 were
related to diagnostic concerns,
she reports, and about 73 percent of the 4,705 diagnostic claims
alleged lapses in clinical judgment, such as failure to order diagnostic
tests, establish a differential diagnoses or give a referral.
Some surveys and research indicate time and scheduling pressures contribute to the potential for error.
At Maine Medical Center, a part of MaineHealth in Portland, began an innovative initiative
to get clinicians thinking about diagnoses. The hospital's
patient-safety officer and clinical educator started a pilot project
that ran from January to July 2011 where doctors voluntarily discussed
examples of diagnostic mistakes. During the trial period, doctors found
36 instances where diseases such as cancer, stroke and pneumonia were
missed, misdiagnosed or not identified in a timely fashion. "Just about
every time you talk to clinicians involved in diagnostic errors, it
seems like time and volume is an issue," said Dr. Robert Trowbridge, an internal medicine physician who teaches clinical reasoning at Maine Medical Center.
Dr. Gordon Schiff, a diagnostic error researcher
at Brigham and Women's Hospital in Boston, told Modernhealthcare.com
that diagnosis is really a team effort. He said the idea that diagnosis
is "this heroic, lone ranger thing" that doctors do behind closed doors
is romantic and outdated.