September 12, 2019
That number varied by specialty. Pediatricians were least likely to say they made errors in their diagnoses every day (11%), and emergency medicine specialists were most likely (26%); while family medicine practitioners (18%), physicians in general practice (22%), and internal medicine professionals (15%) came out somewhere in the middle.
Nurses, advanced practice registered nurses, and physician assistants answered similarly: In all three categories, 17% said they estimated they made diagnostic errors daily.
Respondents included 633 doctors and 118 nurse practitioners, for a total of 751. The poll was conducted after Medscape reported results from a study conducted by the Johns Hopkins School of Medicine in the Journal of General Internal Medicine that suggested doctors tend to underestimate how often they make diagnostic errors.
Researchers at the Baltimore-based school conducted a survey of doctors at nine Connecticut internal medicine training programs to assess thoughts about diagnostic uncertainty and error. Most believed diagnostic errors to be uncommon (once a month or less), although fully half of respondents said they felt diagnostic uncertainty every day. Previously published figures estimate that diagnostic errors happen in 10% to 15% of all patient encounters.
A registered nurse wrote in the comments on the Medscape poll that it’s important to make a distinction between incorrect diagnoses and uncertainty. “The latter is part of the basis for a referral to a specialist,” he noted.
Poll results showed that nurse practitioners and physician assistants reported slightly higher rates of daily diagnostic uncertainty than did doctors. Uncertainty rates were similar for male and female doctors.
Doctors, nurse practitioners, and physician assistants agreed on the top three reasons diagnostic errors happen:
- One was “lack of feedback on diagnostic accuracy” (38% of doctors and 44% of nurse practitioners/physician assistants listed that as a top reason);
- Another was time constraints, listed by 37% of doctors and 47% of nurse practitioners and physician assistants;
- Rounding out the top three was “a culture that discourages disclosure or errors” (according to 27% of doctors; 33% of nurse practitioners/physician assistants).
Finally, an internist said one cause of uncertainty in diagnosis was not listed as an option in the poll —”the inherent nature of biological systems.” Not all symptoms or conditions can be diagnosed, at least in a timely manner, he said.
“We are not ‘omnipotent,’ ” he wrote. “We do not understand in totality human physiology/pathology. Just because a diagnostic ‘label’ cannot be applied to a patient within a certain time, or that a reasonable diagnosis was applied that turns out to be ‘incorrect,’ does not mean an ‘error’ occurred.”
Research contact: @WebMD