Two major contributors to dx error and how to avoid them slides

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Two major contributors to dx error and how to avoid them slides

  1. 1. Best Doctors Physician Webinars Two Major Contributors to Diagnostic Error and How to Avoid Them#dxerror
  2. 2. Two Major Contributors to Diagnostic Error 1. Failure to Consider Differential Diagnoses 2. Communication Breakdowns#dxerror
  3. 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. 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. 5. Cognitive Errors: 320 Faulty Faulty Data Gathering Knowledge 14 % 3% Faulty Synthesis 83 %#dxerror
  6. 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. 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. 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. 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. 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

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