1. Best Doctors
Physician Webinars
Two Major Contributors
to Diagnostic Error
and How to Avoid Them
#dxerror

2. Two Major Contributors to Diagnostic Error
1. Failure to Consider
Differential Diagnoses
2. Communication
Breakdowns
#dxerror

3. Root cause analysis of 100 cases
Graber et al. Diagnostic Error in Internal Medicine
Arch Int Med 165:1493, 2005
SYSTEM Communication,
BLUNT end coordination, training,
policies, procedures
SHARP end Me Cognitive
Patient’s Clinical Course
#dxerror

4. Of all system errors (n = 215),
the most common were:
• Communication & Coordinating care
• Expertise not available when needed
• Breakdowns in testing and alerting
• Supervising trainees
#dxerror

5. Cognitive Errors: 320
Faulty Faulty Data Gathering
Knowledge 14 %
3%
Faulty Synthesis 83 %
#dxerror

6. And How to Avoid Them
1. Generate some initial hypotheses (such as with DDX generators)
2. Pause to reflect – Take a diagnostic “time out”
• Was I comprehensive?
• Did I consider the inherent flaws of heuristic thinking?
• Was my judgment affected by any other bias?
• Do I need to make the diagnosis NOW, or can I wait?
• What’s the worst case scenario? What are the ‘don’t miss’ entities
3. Don’t be afraid to ask a peer physician or an expert
specialist to help you confirm or reconsider your diagnosis
#dxerror

7. DDX Generators
What to look for
J Gen Intern Med. 2012 Feb;27(2):213-9. doi: 10.1007/s11606-011-1804-8.
Differential diagnosis generators: an evaluation of currently available computer programs.
Bond WF, Schwartz LM, Weaver KR, Levick D, Giuliano M, Graber ML.
#dxerror

8. DDX Generators
Input Elements and Methods
J Gen Intern Med. 2012 Feb;27(2):213-9. doi: 10.1007/s11606-011-1804-8.
Differential diagnosis generators: an evaluation of currently available computer programs.
Bond WF, Schwartz LM, Weaver KR, Levick D, Giuliano M, Graber ML.
#dxerror

9. DDX Generators
Content Sources and Linking
J Gen Intern Med. 2012 Feb;27(2):213-9. doi: 10.1007/s11606-011-1804-8.
Differential diagnosis generators: an evaluation of currently available computer programs.
Bond WF, Schwartz LM, Weaver KR, Levick D, Giuliano M, Graber ML.
#dxerror

10. Thank you for joining us!
• Mark your calendars! Thursday, January 24, 8pm ET
Videocast: Harnessing Physicians’ Collective Intelligence
65 year old male with a diagnosis of stage IV signet ring
adenocarcinoma of the appendix (registration available soon)
• Read more on diagnostic error at ClinicalCurbside.com
• Subscribe to our diagnostic accuracy newsletter by emailing
physicians@bestdoctors.com
#dxerror