How to Avoid Misdiagnosis
Written by Editor   
Thursday, June 09, 2016 12:00 AM

A clinician’s attitude toward an individual patient may be a factor in many diagnostic errors.  It’s important to be wary of the possibility of a diagnostic error, in particular a meta-cognitive error.  This means thinking about your thinking and thinking about your feelings and how that affects the outcome.

When the objective is to fix something that’s going wrong, it’s really useful to know how it actually works.  Doing that involves a three step process: data collection, problem representation and subconscious matching.

In the first stage, clinicians gather the patient's history, perform a clinical exam, and consider laboratory tests or imaging. Then, they look for specific details or "golden nuggets" that can direct them to a category of illness. Finally, the clinicians matches the information gleaned to an "illness script" or mental representation plucked from their "internal Rolodex of diseases."

There are three types of these failures or diagnostic errors:

  • No fault errors: When the patient actively undermines the diagnostic process

  • Systems related errors: When faulty tests or faulty data, inadequate supervision of trainees, poor communication, or an organizational failure get in the way of a correct diagnosis

  • Cognitive errors: When faulty knowledge, faulty data gathering, faulty synthesis of information, or affective error impact the diagnosis.

Rarely is their only one cause of an error.

“Faulty knowledge,” occurs when a clinician may have seen an illness that presented in an unfamiliar way. If you don’t have that illness script for whatever that disease is, you're not going to be able to make that diagnosis.

With faulty data gathering, clinicians may gloss over important diagnostic questions, fail to conduct a comprehensive clinical exam, or disregard patient history. These type of errors are common when clinicians feel overwhelmed by time pressures.

Faulty synthesis happens when clinicians solve a puzzle too quickly, often overestimating the importance of a single finding. Also called “premature closure” this may be the most common cause of diagnostic error.  Diagnostic uncertainty really bothers the common doctor and it bothers patients too. So many push to make a diagnosis, because then it provides a degree of "certainty.”

The first step in improving diagnostic reasoning is awareness of the risk for cognitive errors. Experience, seeing as many patients as possible, is also important to expanding firsthand knowledge of diseases.  In addition, to improve intuitive reasoning gaining feedback on diagnoses was critical.  When doctors guess at a diagnosis and don’t know what happened later, they assume they got it right.  Many times they were not right and that reinforces doing things incorrectly.