Blog | Thursday, April 25, 2013

QD: News Every Day--Knowledge gaps, short patient visits cited as reasons for fouled diagnoses

Knowledge gaps and short patient visits were cited by physicians as to major contributors to diagnostic errors, a study reported.

Diagnostic errors were the most common, costly and dangerous of medical mistakes among malpractice claims, as was reported yesterday.

In a separate study, researchers surveyed primary care physicians in an integrated health system across 10 geographically dispersed states in 2005 about barriers to timely diagnosis in the outpatient setting and assessed their perceptions of diagnostic difficulty. The survey also included two open-ended questions, the first about a specific incident of delayed diagnosis and a second that asked for suggestions to reduce delays in diagnosis.

Authors examined the extent and predictors of diagnostic difficulty, defined as reporting more than 5% patients difficult to diagnose. Results appeared in BMJ Quality & Safety.

Of more than 1,000 respondents, inadequate knowledge (19.9%) was the most commonly reported cognitive factor. Half reported more than 5% of their patients were difficult to diagnose; more experienced physicians reported less diagnostic difficulty.

The most common cognitive issue reported was inadequate knowledge base (19.9%), followed by inadequate detection or perception of a clinical problem (12.7%). Also reported were misidentification of a symptom or sign (6.8%) or overestimation of the reliability or saliency of a finding (9.2%).

Open-ended suggestions to reduce diagnostic delays included lengthening patient visits, reducing panel sizes and assigning nonclinical work to non-physicians (21%). Also, respondents cited wait times for diagnostic tests and for results to be conveyed to physicians and patients (13%) as areas of improvement, and that improved access to specialists would reduce diagnostic delays (10%).

Researchers noted that knowledge gaps appear to be a prominent concern among primary care physicians.

They wrote, "Misdiagnosis relates to several system and cognitive factors but knowledge gaps might be more often responsible than previously estimated. Interventions that address practice level issues such as time to process diagnostic information and better subspecialty input might potentially reduce diagnostic safety concerns in primary care."