Predictors of Diagnostic Accuracy and Safe Management in Difficult Diagnostic Problems in Family Medicine

Olga Kostopoulou, Jurriaan Oudhoff, Radhika Nath, Brendan C. Delaney, Craig W. Munro, Clare Harries and Roger Holder
Additional contact information
Olga Kostopoulou: Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK, o.kostopoulou@bham.ac.uk
Jurriaan Oudhoff: Department of Primary Care, University of Birmingham, United Kingdom
Radhika Nath: Department of Primary Care, University of Birmingham, United Kingdom
Brendan C. Delaney: Department of Primary Care, University of Birmingham, United Kingdom
Craig W. Munro: Department of Primary Care, University of Birmingham, United Kingdom
Clare Harries: Department of Psychology, University College London, United Kingdom
Roger Holder: Department of Primary Care, University of Birmingham, United Kingdom

Medical Decision Making, 2008, vol. 28, issue 5, 668-680

Abstract: Objective. To investigate the role of information gathering and clinical experience on the diagnosis and management of difficult diagnostic problems in family medicine. Method. Seven diagnostic scenarios including 1 to 4 predetermined features of difficulty were constructed and presented on a computer to 84 physicians: 21 residents in family medicine, 21 family physicians with 1 to 3 y in practice, and 42 family physicians with ≥ 10 y in practice. Following the Active Information Search process tracing approach, participants were initially presented with a patient description and presenting complaint and were subsequently able to request further information to diagnose and manage the patient. Evidence-based scoring criteria for information gathering, diagnosis, and management were derived from the literature and a separate study of expert opinion. Results. Rates of misdiagnosis were in accordance with the number of features of difficulty. Seventy-eight percent of incorrect diagnoses were followed by inappropriate management and 92% of correct diagnoses by appropriate management. Number of critical cues requested (cues diagnostic of any relevant differential diagnoses in a scenario) was a significant predictor of accuracy in 6 scenarios: 1 additional critical cue increased the odds of obtaining the correct diagnosis by between 1.3 (95% confidence interval [CI], 1.0 — 1.8) and 7.5 (95% CI, 3.2 — 17.7), depending on the scenario. No effect of experience was detected on either diagnostic accuracy or management. Residents requested significantly more cues than experienced family physicians did. Conclusions. Supporting the gathering of critical information has the potential to improve the diagnosis and management of difficult problems in family medicine.

Keywords: Key words: diagnosis; error; information gathering; experience; process tracing; family practice. (search for similar items in EconPapers)
Date: 2008
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Citations: View citations in EconPapers (5)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:28:y:2008:i:5:p:668-680

DOI: 10.1177/0272989X08319958

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