Avoiding Misdiagnosis
Monday, February 12, 2007
It's interesting and telling that some of the issues discussed in How Doctors Think are also starting to be more carefully considered in the world of medicine. A recent article in the New England Journal of Medicine presented a case study of a patient that was originally diagnosed incorrectly due to anchor heuristics. As the study explains,Heuristics are learned shortcuts that all clinicians use to improve the efficiency of the diagnostic process. Unfortunately, they can also lead to diagnostic errors…The anchoring heuristic occurs when the estimation of the likelihood of a diagnosis is based heavily on initial test results or on a previous diagnosis.
Calfee, Carolyn S. et al. Anchors Away. N Engl J Med. 2007;356:5049.
This trend toward analyzing thought processes and how patients are diagnosed and therefore treated is a very promising one. It isn't that this shortcut approach to diagnosis is wrong. Recognizing a pattern of symptoms can lead to early action and save lives. This speed and efficiency is also vital in a profession that is notoriously short on time. However, as shown in the case study, this approach does have its drawbacks and once a wrong diagnosis has been made, it can be difficult to rethink the problem from a different angle. The most effective doctors use this shortcut method yet are also self aware enough to recognize possible pitfalls and consider alternative options.
Misdiagnosis most often stems from cognitive errors, meaning that the more consideration is put into the thought process that doctors use the more accurate treatment can become. So it is gratifying that more attention is being given and that publications such as the New England Journal are increasingly discussing this aspect of medicine.
