Do my feelings fit the diagnosis? Avoiding misdiagnoses in psychosomatic consultation services.
cognitive bias
dual process theory
misdiagnosis
nonrational diagnostic process
psychosomatic consultation services
systematic introspection
Journal
Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management
ISSN: 2040-0861
Titre abrégé: J Healthc Risk Manag
Pays: United States
ID NLM: 9305245
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
pubmed:
13
1
2021
medline:
29
10
2021
entrez:
12
1
2021
Statut:
ppublish
Résumé
Misdiagnoses are a major concern with far-reaching consequences, which have rarely been studied systematically. Therefore, the present study evaluated factors causing misdiagnoses identified by psychosomatic consultation services. Over a period of 5 years, all patients referred to the psychosomatic consultation services of a large university hospital were analyzed consecutively for misdiagnoses. We analyzed the reasons for suspecting a misdiagnosis through systematic introspection during peer supervision and evaluated the causes during semistructured interviews with the referring physician. In 165 psychosomatic consultations, 24 disorders were misdiagnosed (15%). The reasons for questioning the initial diagnoses were the consulting physician's feelings and thoughts resulting from the patients' inappropriate behavior during the consultation and unusual clinical features. In eight cases, the misdiagnosis resulted from availability bias, and in three cases each it resulted from confirmation bias, search satisfaction bias, and framing effect and attribution bias. However, lack of medical knowledge played only a minor role. This study highlights the nonrational elements of the diagnostic process. In the context of psychosomatic consultation services, introspection and intuitive thought processes are helpful in identifying misdiagnoses. Self-satisfaction (availability bias) and overconfidence (confirmation bias) are most likely to result in misdiagnoses.
Types de publication
Journal Article
Langues
eng
Pagination
9-17Informations de copyright
© 2021 The Authors. Journal of Healthcare Risk Management published by Wiley Periodicals LLC on Behalf of American Society for Healthcare Risk Management.
Références
Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145:488-496.
Zwaan L, Thijs A, Wagner C, et al. Relating faults in diagnostic reasoning with diagnostic errors and patient harm. Acad Med. 2012;87:149-156.
WHO. World Alliance for Patient Safety: WHO Draft Guidelines for Adverse Event Reporting and Learning Systems: From Information to Action. WHO/EIP/SPO/QPS/05.3. 2005. Geneva, Switzerland: World Health Organization. https://apps.who.int/iris/handle/10665/69797. Accessed August 14, 2020.
Gausmann P, Koppenberg J, Henninger M. Patientensicherheitsmanagement. Berlin, Germany: De Gruyter; 2015.
Rall M, Martin G, Geldner G, et al. Charakteristika effektiver incident-reporting-systeme zur erhöhung der patientensicherheit. Anästhesiologie Intensivmedizin 2006:47;9-19.
Reason J. Human error: models and management. BMJ. 2000;320:768-770.
Hoffmann B, Rohe J. Patient safety and error management: what causes adverse events and how can they be prevented? Dtsch Arztebl Int. 2010;107:92-99.
Groszkruger D. Diagnostic error: untapped potential for improving patient safety? J Healthc Risk Manag. 2014;34:38-43.
Singh H, Schiff GD, Graber ML, et al. The global burden of diagnostic errors in primary care. BMJ Qual Saf. 2017;26:484-494.
Graber ML, Trowbridge R, Myers JS, et al. The next organizational challenge: finding and addressing diagnostic error. JCJQPS. 2014;40:102-110.
Newman-Toker DE, Pronovost PJ. Diagnostic errors-the next frontier for patient safety. JAMA. 2009;301:1060-1062.
Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121:S2-23.
Slater ET, Glithero E. A follow-up of patients diagnosed as suffering from ‘hysteria’. J Psychosom Res. 1965;9:9-13.
Crimlisk HL, Bhatia K, Cope H, et al. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ 1998;316:582-586.
Stone J, Smyth R, Carson A, et al. Systematic review of misdiagnosis of conversion symptoms and “hysteria”. BMJ. 2005;331:989-995.
Graber M. Diagnostic errors in medicine: a case of neglect. Jt Comm J Qual Patient Saf. 2005;31:106-113.
Wachter RM. Why diagnostic errors don't get any respect-and what can be done about them. Health Affairs. 2010;29:1605-1610.
Koyama A, Ohtake Y, Yasuda K, et al. Avoiding diagnostic errors in psychosomatic medicine: a case series study. BioPsychoSoc Med. 2018;12:4.
Rüger. Fehldiagnose Psychosomatische Erkrankung. Prax Psychother Psychosom. 1987;32:12-20.
Lamparter U, Schmidt HU. Wirklich psychisch bedingt? Somatische Differenzialdiagnosen in der Psychosomatischen Medizin und Psychotherapie. 1st ed. Stuttgart, Germany: Schattauer; 2017.
Croskerry P. From mindless to mindful practice-cognitive bias and clinical decision making. N Engl J Med. 2013;368:2445-2448.
Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013;22:21-27.
Graber ML, Wachter RM, Cassel CK. Bringing diagnosis into the quality and safety equations. JAMA. 2012;308:1211-1212.
Kahneman D. Thinking, Fast and Slow. 1 ed. London, England: Penguin; 2012.
Taib IA, McIntosh AS, Caponecchia C, et al. A review of medical error taxonomies: a human factors perspective. Safety Sci. 2011;49:607-615.
Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ. 2007;41:1140-1145.
Evans J. Dual-processing accounts of reasoning, judgment, and social cognition. Annu Rev Psychol. 2008;59:255-278.
Kahneman D, Frederick S. Representativeness revisited: Attribute substitution in intuitive judgment. In: Griffin D, Kahneman D, Gilovich T, eds. Heuristics and Biases: The Psychology of Intuitive Judgment. Cambridge, England: Cambridge University Press; 2002, pp. 49-81.
Dougherty MRP, Franco-Watkins AM. Who is rational: Studies of individual differences in reasoning. Appl Cogn Psychol. 2000;14:595-597.
McLaughlin K, Eva KW, Norman GR. Reexamining our bias against heuristics. Adv Health Sci Educ Theory Pract. 2014;19:457-464.
Döring S, Schüssler G, Laireiter AR. Diagnostik in der Psychosomatik. Wien, NY: Springer; 2000.
Rudolf G, Henningsen P. Psychotherapeutische medizin und psychosomatik. Ein einführendes Lehrbuch auf psychosomatischer Grundlage. Stuttgart, Germany: Thieme; 2017.
Söllner W. Diagnostik im Psychotherapeutischen Konsultations-/Liaisondienst. In: Laireiter A-R, ed. Diagnostik in der Psychotherapie. Vienna, Austria: Springer; 2000, pp. 389-404.
Steindel SJ. International classification of diseases, 10th edition, clinical modification and procedure coding system: descriptive overview of the next generation HIPAA code sets. J Am Med Inform Assoc. 2010;17:274-282.
Lowry F. Failure to perform autopsies means some MDs ‘walking in a fog of misplaced optimism’. CMAJ. 1995;153:811-814.
Cavalcanti R, Sibbald M. Am I right when I am sure? Data consistency influences the relationship between diagnostic accuracy and certainty. ACAD Med 2014;89:107-13.
Gigerenzer G, Kober H. Bauchentscheidungen: Die Intelligenz des Unbewussten und die Macht der Intuition. Gütersloh, Germany: Bertelsmann; 2007.
Seidl O. Als psychoanalytiker im psychosomatischen konsiliardienst. Forum der Psychoanalyse 1997;13:338-352.