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"Diagnostic errors."
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Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment
BackgroundLiterature suggests that patients who display disruptive behaviours in the consulting room fuel negative emotions in doctors. These emotions, in turn, are said to cause diagnostic errors. Evidence substantiating this claim is however lacking. The purpose of the present experiment was to study the effect of such difficult patients’ behaviours on doctors’ diagnostic performance.MethodsWe created six vignettes in which patients were depicted as difficult (displaying distressing behaviours) or neutral. Three clinical cases were deemed to be diagnostically simple and three deemed diagnostically complex. Sixty-three family practice residents were asked to evaluate the vignettes and make the patient's diagnosis quickly and then through deliberate reflection. In addition, amount of time needed to arrive at a diagnosis was measured. Finally, the participants rated the patient's likability.ResultsMean diagnostic accuracy scores (range 0–1) were significantly lower for difficult than for neutral patients (0.54 vs 0.64; p=0.017). Overall diagnostic accuracy was higher for simple than for complex cases. Deliberate reflection upon the case improved initial diagnostic, regardless of case complexity and of patient behaviours (0.60 vs 0.68, p=0.002). Amount of time needed to diagnose the case was similar regardless of the patient's behaviour. Finally, average likability ratings were lower for difficult than for neutral-patient cases.ConclusionsDisruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likability and diagnostic performance.
Journal Article
Why patients’ disruptive behaviours impair diagnostic reasoning: a randomised experiment
BackgroundPatients who display disruptive behaviours in the clinical encounter (the so-called ‘difficult patients’) may negatively affect doctors’ diagnostic reasoning, thereby causing diagnostic errors. The present study aimed at investigating the mechanisms underlying the negative influence of difficult patients’ behaviours on doctors’ diagnostic performance.MethodsA randomised experiment with 74 internal medicine residents. Doctors diagnosed eight written clinical vignettes that were exactly the same except for the patients’ behaviours (either difficult or neutral). Each participant diagnosed half of the vignettes in a difficult patient version and the other half in a neutral version in a counterbalanced design. After diagnosing each vignette, participants were asked to recall the patient's clinical findings and behaviours. Main measurements were: diagnostic accuracy scores; time spent on diagnosis, and amount of information recalled from patients’ clinical findings and behaviours.ResultsMean diagnostic accuracy scores (range 0–1) were significantly lower for difficult than neutral patients’ vignettes (0.41 vs 0.51; p<0.01). Time spent on diagnosing was similar. Participants recalled fewer clinical findings (mean=29.82% vs mean=32.52%; p<0.001) and more behaviours (mean=25.51% vs mean=17.89%; p<0.001) from difficult than from neutral patients.ConclusionsDifficult patients’ behaviours induce doctors to make diagnostic errors, apparently because doctors spend part of their mental resources on dealing with the difficult patients’ behaviours, impeding adequate processing of clinical findings. Efforts should be made to increase doctors’ awareness of the potential negative influence of difficult patients’ behaviours on diagnostic decisions and their ability to counteract such influence.
Journal Article
Breathe : a novel
\"Amid a starkly beautiful but uncanny landscape in New Mexico, a married couple from Cambridge, MA takes residency at a distinguished academic institute. When the husband is stricken with a mysterious illness, misdiagnosed at first, their lives are uprooted and husband and wife each embarks upon a nightmare journey. At thirty-seven, Michaela faces the terrifying prospect of widowhood - and the loss of Gerard, whose identity has greatly shaped her own.\"-- Jacket flap.
Book
25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank
Background We sought to characterise the frequency, health outcomes and economic consequences of diagnostic errors in the USA through analysis of closed, paid malpractice claims. Methods We analysed diagnosis-related claims from the National Practitioner Data Bank (1986–2010). We describe error type, outcome severity and payments (in 2011 US dollars), comparing diagnostic errors to other malpractice allegation groups and inpatient to outpatient within diagnostic errors. Results We analysed 350 706 paid claims. Diagnostic errors (n=100 249) were the leading type (28.6%) and accounted for the highest proportion of total payments (35.2%). The most frequent outcomes were death, significant permanent injury, major permanent injury and minor permanent injury. Diagnostic errors more often resulted in death than other allegation groups (40.9% vs 23.9%, p<0.001) and were the leading cause of claims-associated death and disability. More diagnostic error claims were outpatient than inpatient (68.8% vs 31.2%, p<0.001), but inpatient diagnostic errors were more likely to be lethal (48.4% vs 36.9%, p<0.001). The inflation-adjusted, 25-year sum of diagnosis-related payments was US$38.8 billion (mean per-claim payout US$386 849; median US$213 250; IQR US$74 545–484 500). Per-claim payments for permanent, serious morbidity that was ‘quadriplegic, brain damage, lifelong care’ (4.5%; mean US$808 591; median US$564 300), ‘major’ (13.3%; mean US$568 599; median US$355 350), or ‘significant’ (16.9%; mean US$419 711; median US$269 255) exceeded those where the outcome was death (40.9%; mean US$390 186; median US$251 745). Conclusions Among malpractice claims, diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes. We found roughly equal numbers of lethal and non-lethal errors in our analysis, suggesting that the public health burden of diagnostic errors could be twice that previously estimated. Healthcare stakeholders should consider diagnostic safety a critical health policy issue.
Journal Article
Debunking ADHD : 10 reasons to stop drugging kids for acting like kids
The time has come for debunking ADHD and exposing how this invented disorder created to drug children that does not exist. Despite unanimous agreement that no test exists to identify ADHD, 6.4 million American children are labeled with ADHD. To make matters worse, approximately two-thirds of those children diagnosed with ADHD are prescribed drugs with many dangerous side effects, which include more serious mental disorders and death. After six decades of marketing stimulants and scaring parents into thinking something is seriously wrong with their highly creative, energetic, and communicative children, ADHD drug manufacturers still claim they have no idea what ADHD drugs actually do to children's brains. They make such claims when research shows ADHD drugs cause permanent brain damage in lab animals. How can children dream about achieving greatness, reach their full potenial, and release their creative imagination when they are drugged every day, year after year, to do the opposite? -- This book provides adults with the evidence to say no to ADHD, the help they need to raise slightly annoying children, and 10 Reasons to Stop Drugging Kids for Acting Like Kids! -- Book Cover
Book
Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review
BackgroundDiagnostic error incurs enormous human and economic costs. The dual-process model reasoning provides a framework for understanding the diagnostic process and attributes certain errors to faulty cognitive shortcuts (heuristics). The literature contains many suggestions to counteract these and to enhance analytical and non-analytical modes of reasoning.AimsTo identify, describe and appraise studies that have empirically investigated interventions to enhance analytical and non-analytical reasoning among medical trainees and doctors, and to assess their effectiveness.MethodsSystematic searches of five databases were carried out (Medline, PsycInfo, Embase, Education Resource Information Centre (ERIC) and Cochrane Database of Controlled Trials), supplemented with searches of bibliographies and relevant journals. Included studies evaluated an intervention to enhance analytical and/or non-analytical reasoning among medical trainees or doctors.FindingsTwenty-eight studies were included under five categories: educational interventions, checklists, cognitive forcing strategies, guided reflection, instructions at test and other interventions. While many of the studies found some effect of interventions, guided reflection interventions emerged as the most consistently successful across five studies, and cognitive forcing strategies improved accuracy and confidence judgements. Significant heterogeneity of measurement approaches was observed, and existing studies are largely limited to early-career doctors.ConclusionsResults to date are promising and this relatively young field is now close to a point where these kinds of cognitive interventions can be recommended to educators. Further research with refined methodology and more diverse samples is required before firm recommendations may be made for medical education and policy; however, these results suggest that such interventions hold promise, with much current enthusiasm for new research.
Journal Article
Brain on fire : my month of madness
\"When twenty-four-year-old Susannah Cahalan woke up alone in a hospital room, strapped to her bed and unable to move or speak, she had no memory of how she'd gotten there. Days earlier, she had been on the threshold of a new, adult life: at the beginning of her first serious relationship and a promising career at a major New York newspaper. Now she was labeled violent, psychotic, a flight risk. What happened? In a swift and breathtaking narrative, [the author] tells the astonishing true story of her descent into madness, her family's inspiring faith in her, and the lifesaving diagnosis that nearly didnt happen\"--Amazon.com.
Book
How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China
Background
Diagnostic errors remain a pressing challenge in health systems with uneven provider capacity and limited diagnostic standardization. In such environments, cognitive biases, particularly anchoring effect, may compromise diagnostic independence and reinforce structural disparities in care quality.
Methods
We conducted a randomized field experiment in western China using standardized patients (SPs) to examine how prior spectacle diagnostic prescriptions influence the behavior and accuracy of second-opinion optometrists. SPs visited optical providers in Shaanxi province, presenting either no prior prescription, a correct one, or an incorrect one. Diagnostic outcomes were evaluated against gold-standard prescriptions issued by an expert ophthalmologist.
Results
Exposure to prior prescriptions, especially inaccurate ones, significantly reduced diagnostic accuracy and process completeness. Providers given prior diagnoses were less likely to conduct key tests and spent less time on examinations, suggesting reliance on cognitive shortcuts. These findings provide field-based evidence of anchoring bias in real-world clinical settings.
Conclusions
Prior diagnostic information can shape second-opinion decision-making through cognitive anchoring, particularly in systems lacking strong institutional protocols. Addressing these biases through structured diagnostic procedures and provider training may enhance diagnostic accuracy and promote greater equity in vision care delivery.
Journal Article