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    Overconfident Docs Need Dose of Reality

    Misdiagnoses Occur up to 15% of the Time, and Physician Overconfidence May Be Partly to Blame, Study Shows

    Barriers to Patient Follow-up

    In one of the newly published essays, Gordon D. Schiff, MD, associate director of the Center for Patient Safety Research and Practice at Brigham and Women's Hospital, addressed the barriers to the follow-up of patients in the real-world, clinical practice setting.

    Not surprisingly, lack of time was at the top of his list, followed by fragmentation of care, the large number of symptoms for which there is no clear diagnosis, cost and managed care barriers, and physician defensiveness about critical feedback from peers.

    "Learning and feedback are inseparable," Schiff writes. "The old tools (used by physicians) -- individual idiosyncratic systems to track patients, reliance on human memory, and patient adherence to or initiating of follow-up appointments -- are too unreliable to be depended upon to ensure high quality in modern diagnosis."

    He calls for a systematic approach to link diagnoses with patient outcomes.

    In a different essay, Mark Graber, MD, of the department of medicine at State University of New York at Stony Brook and VA Medical Center in Northport, N.Y., proposes new roles for patients that can help. One is to have the patient become a "watchdog for cognitive errors" by having doctors communicate to patients more about what diagnoses they are considering rather than just telling patients what tests to get or what medications to take. Sharing more information with patients can help patients be more active in checking for errors.

    A second role is as a "watchdog for system-related errors" to help keep track of their own medical information such as test results and medication lists. By doing so, "the patient can play a valuable role in combating errors related to latent flaws in our healthcare systems and practices," Graber writes.

    Berner adds that patients can help by questioning their doctors carefully during the diagnostic process, and, especially, letting them know when they might have made the wrong call.

    "If your doctor says you should be better in a week, and you aren't, call the office and let them know," she says, adding that a surprising number of patients do not do this.

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