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
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
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,"
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.