Accuracy, Overconfidence and Lack of time
Jason.Maude at ISABELHEALTHCARE.COM
Thu Aug 29 11:17:31 UTC 2013
3 very interesting papers have just been published in JAMA:
* http://archinte.jamanetwork.com/article.aspx?articleid=1731967 Looks at dx accuracy, confidence and resources requests
* http://archinte.jamanetwork.com/article.aspx?articleid=1731968 Looks at barriers to answering clinical questions at the point of care
* http://archinte.jamanetwork.com/article.aspx?articleid=1731959 Great commentary by Gurpreet Dhaliwal that ties the 2 articles together
These papers raise several interesting issues:
1. The study on dx accuracy and confidence is brilliant and the authors are to be congratulated. However, the results that show an accuracy rate of 55% for the easy cases and just 6% for the harder cases are truly shocking and the authors statement that "overall diagnostic accuracy was rather low- 31% across the 4 cases" must be the understatement of the year. This means that almost 70% are getting it wrong making it highly likely that patients will incur lots of expensive treatment for the wrong diagnosis. I may be missing something here but I can't see how this magnitude of poor performance can be ignored.
2. Accuracy of diagnosis appears to have been barely affected after the history and physical stages with labs and imaging, begging the question what is the point of all that expensive testing?
3. Lack of time did NOT seem to be an issue in the low levels of accuracy. It seems that the high levels of confidence meant that the physicians did not request additional resources. Rather than the term 'over confidence' I think a more apt explanation is the "illusion of knowledge". The over confidence results from the illusion of knowledge.
4. Time is cited as the major barrier to physicians using information resources in the paper on barriers to getting clinical questions answered but this does not square with the results from the accuracy study where they had lots of time. My personal view is that often a lack of time is simply an excuse not to do something which is either not perceived as sufficiently important or where the person believes they know what they need to already.
5. One of the solutions suggested in the dx accuracy study is "engaging patients in creative ways" which I think could be actively encouraging patients to use sophisticated symptom checkers before the consultation so that they can contribute more productively.
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