Overconfident Docs Need Dose of Reality
Misdiagnoses Occur up to 15% of the Time, and Physician Overconfidence May Be Partly to Blame, Study Shows
April 29, 2008 -- Most of the time a medical diagnosis is on point. But
misdiagnoses do occur, and an overly confident doctor may be partly to blame, a
new review suggests.
The rate of diagnostic error is as high as 15%, Eta S. Berner, EdD, and Mark
L.. Graber, MD, write in a special edition of The American Journal of
Medicine dedicated to understanding and addressing diagnostic errors.
Physician overconfidence and a lack of feedback following a diagnosis are
two important contributors to the problem, they note.
"When directly questioned, many clinicians find it inconceivable that
their own error rate could be as high as the literature demonstrates,"
Berner and Graber write. "They acknowledge that diagnostic error exists,
but believe the rate is very low, and that any errors are made by others who
are less skillful or less careful."
Berner says it is often the cases physicians perceive as routine and
unchallenging that end up being misdiagnosed.
"With the hard cases, doctors generally seek out different opinions or
turn to (computer-based) decision support tools," she tells WebMD.
(Have you ever
been misdiagnosed? Tell us about it on WebMD's
Health Cafe message board.)
A Missed Diagnosis
Retired engineer Paul Mongerson is all too aware of the problem of medical
misdiagnosis, and he has spent the last 28 years addressing the issue.
In 1980, Mongerson was incorrectly told by four different doctors that he
had pancreatic cancer, a highly
deadly cancer that kills most people
who have it within five years.
Mongerson made up a matrix charting his symptoms and test results to help
him assess the probability that his doctors were right.
"I determined from that matrix that I didn't have cancer," he tells
Just two days before he was scheduled for cancer surgery, a fifth doctor
agreed and Mongerson canceled the operation.
"I said at the time that if I survived I was going to see what I could
do to help other people," he says.
What Mongerson did was form a foundation to fund the development of
computer-based programs designed to assist physicians in diagnosing
While such programs are being used in many hospital and educational
settings, they are not yet widely used by private practice physicians.
Mongerson says performing more autopsies and having systems in place to
crosscheck medical diagnoses would help address the issue of lack of
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.