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Reflections on Diagnosis and Diagnostic Errors: a Survey of Internal Medicine Resident and Attending Physicians

  • Thilan P. WijesekeraEmail author
  • Lisa Sanders
  • Donna M. Windish
Concise Research Reports

INTRODUCTION

More than three years since the National Academy of Medicine (NAM) report “Improving Diagnosis in Health Care,” providers and educators are still trying to understand why diagnostic errors occur and how to reduce them.1 In this survey study, internal medicine physicians share insights on how they make diagnoses and approach diagnostic error.

METHODS

From June 2016 through March 2017, we surveyed 484 residents and attendings from nine Connecticut internal medicine training programs. Surveys (electronic or paper) included single-answer, multiple choice questions about frequency of diagnostic uncertainty, diagnostic errors and considering harms and benefits of diagnostic testing (every patient, ≥ 2 times per day, once daily, ≥ 2 times per week, once weekly, once per month, and never), source of diagnostic errors (access, history, physical, testing, assessment, referral, follow-up), factors negatively impacting diagnosis (time, electronic health record and patient factors:...

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. Washington, DC: National Academies Press; 2016.Google Scholar
  2. 2.
    Bhise V, Rajan SS, Sitting D, et al. Defining and measuring diagnostic uncertainty in medicine: a systemic review. J Gen Intern Med. 2018;33(1):103–115.CrossRefGoogle Scholar
  3. 3.
    Safford MM. The complexity of complex patients. J Gen Intern Med. 2015;30(12):1724–5.CrossRefGoogle Scholar
  4. 4.
    Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165(11):753–60.CrossRefGoogle Scholar
  5. 5.
    Brodersen J, Kramer BS, Macdonald H, Schwartz LM, Woloshin S. Focusing on overdiagnosis as a driver of too much medicine. BMJ. 2018;362:k3494.CrossRefGoogle Scholar
  6. 6.
    Levinson W, Kallewaard M, Bhatia RS, et al. ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf. 2015;24(2):167–74.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Yale Department Internal MedicineYale University School of MedicineNew HavenUSA

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