two major contributors to dx error and how to avoid them slides
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#dxerror
and How to Avoid Them
Best DoctorsPhysician Webinars
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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