two major contributors to dx error and how to avoid them slides

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and How to Avoid Them

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Two Major Contributorsto Diagnostic Error

Two Major Contributors to Diagnostic Error

1. Failure to Consider Differential Diagnoses

2. Communication Breakdowns

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BLUNT end

SHARP end

Patient’s Clinical Course

SYSTEM

Me

Root cause analysis of 100 casesGraber et al. Diagnostic Error in Internal Medicine

Arch Int Med 165:1493, 2005

Communication, coordination, training, policies, procedures

Cognitive

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Of all system errors (n = 215), the most common were:

• Communication & Coordinating care• Expertise not available when needed• Breakdowns in testing and alerting• Supervising trainees

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Cognitive Errors: 320

Faulty Synthesis 83 %

Faulty Knowledge

3 %

Faulty Data Gathering 14 %

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And How to Avoid Them

1. Generate some initial hypotheses (such as with DDX generators)

2. Pause to reflect – Take a diagnostic “time out”• Was I comprehensive?

• Did I consider the inherent flaws of heuristic thinking?

• Was my judgment affected by any other bias?

• Do I need to make the diagnosis NOW, or can I wait?

• What’s the worst case scenario? What are the ‘don’t miss’ entities

3. Don’t be afraid to ask a peer physician or an expert specialist to help you confirm or reconsider your diagnosis

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DDX GeneratorsWhat to look for

J Gen Intern Med. 2012 Feb;27(2):213-9. doi: 10.1007/s11606-011-1804-8.Differential diagnosis generators: an evaluation of currently available computer programs.Bond WF, Schwartz LM, Weaver KR, Levick D, Giuliano M, Graber ML.

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DDX GeneratorsInput Elements and Methods

J Gen Intern Med. 2012 Feb;27(2):213-9. doi: 10.1007/s11606-011-1804-8.Differential diagnosis generators: an evaluation of currently available computer programs.Bond WF, Schwartz LM, Weaver KR, Levick D, Giuliano M, Graber ML.

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DDX GeneratorsContent Sources and Linking

J Gen Intern Med. 2012 Feb;27(2):213-9. doi: 10.1007/s11606-011-1804-8.Differential diagnosis generators: an evaluation of currently available computer programs.Bond WF, Schwartz LM, Weaver KR, Levick D, Giuliano M, Graber ML.

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