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

Author

Listed:
  • 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)

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.

Suggested Citation

  • Olga Kostopoulou & Jurriaan Oudhoff & Radhika Nath & Brendan C. Delaney & Craig W. Munro & Clare Harries & Roger Holder, 2008. "Predictors of Diagnostic Accuracy and Safe Management in Difficult Diagnostic Problems in Family Medicine," Medical Decision Making, , vol. 28(5), pages 668-680, September.
    • Handle: RePEc:sae:medema:v:28:y:2008:i:5:p:668-680
    DOI: 10.1177/0272989X08319958
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    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
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    Cited by:

    1. Martine Nurek & Olga Kostopoulou & York Hagmayer, 2014. "Predecisional information distortion in physicians' diagnostic judgments: Strengthening a leading hypothesis or weakening its competitor?," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 9(6), pages 572-585, November.
    2. Nicholas Riches & Maria Panagioti & Rahul Alam & Sudeh Cheraghi-Sohi & Stephen Campbell & Aneez Esmail & Peter Bower, 2016. "The Effectiveness of Electronic Differential Diagnoses (DDX) Generators: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-26, March.
    3. repec:cup:judgdm:v:9:y:2014:i:6:p:572-585 is not listed on IDEAS
    4. Matthew D. Blanchard & Stefan M. Herzog & Juliane E. Kämmer & Nikolas Zöller & Olga Kostopoulou & Ralf H. J. M. Kurvers, 2024. "Collective Intelligence Increases Diagnostic Accuracy in a General Practice Setting," Medical Decision Making, , vol. 44(4), pages 451-462, May.
    5. repec:cup:judgdm:v:4:y:2009:i:5:p:408-418 is not listed on IDEAS
    6. Olga Kostopoulou & Christos Mousoulis & Brendan Delaney, 2009. "Information search and information distortion in the diagnosis of an ambiguous presentation," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 4(5), pages 408-418, August.
    7. Marieke de Vries & Cilia L. M. Witteman & Rob W. Holland & Ap Dijksterhuis, 2010. "The Unconscious Thought Effect in Clinical Decision Making: An Example in Diagnosis," Medical Decision Making, , vol. 30(5), pages 578-581, September.

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