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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
WebMD Health News
Reviewed by Louise Chang, MD

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 WebMD.

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 disease.

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 feedback.

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