z-logo
open-access-imgOpen Access
Do Physicians Know When Their Diagnoses Are Correct?
Author(s) -
Friedman Charles P.,
Gatti Guido G.,
Franz Timothy M.,
Murphy Gwendolyn C.,
Wolf Fredric M.,
Heckerling Paul S.,
Fine Paul L.,
Miller Thomas M.,
Elstein Arthur S.
Publication year - 2005
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2005.30145.x
Subject(s) - medical diagnosis , medicine , confidence interval , correctness , family medicine , medline , psychological intervention , psychiatry , radiology , algorithm , computer science , political science , law
Objective: This study explores the alignment between physicians' confidence in their diagnoses and the “correctness” of these diagnoses, as a function of clinical experience, and whether subjects were prone to over‐or underconfidence. Design: Prospective, counterbalanced experimental design. Setting: Laboratory study conducted under controlled conditions at three academic medical centers. Participants: Seventy‐two senior medical students, 72 senior medical residents, and 72 faculty internists. Intervention: We created highly detailed, 2‐to 4‐page synopses of 36 diagnostically challenging medical cases, each with a definitive correct diagnosis. Subjects generated a differential diagnosis for each of 9 assigned cases, and indicated their level of confidence in each diagnosis. Measurements And Main Results: A differential was considered “correct” if the clinically true diagnosis was listed in that subject's hypothesis list. To assess confidence, subjects rated the likelihood that they would, at the time they generated the differential, seek assistance in reaching a diagnosis. Subjects' confidence and correctness were “mildly” aligned (κ=.314 for all subjects, .285 for faculty, .227 for residents, and .349 for students). Residents were overconfident in 41% of cases where their confidence and correctness were not aligned, whereas faculty were overconfident in 36% of such cases and students in 25%. Conclusions: Even experienced clinicians may be unaware of the correctness of their diagnoses at the time they make them. Medical decision support systems, and other interventions designed to reduce medical errors, cannot rely exclusively on clinicians' perceptions of their needs for such support.

The content you want is available to Zendy users.

Already have an account? Click here to sign in.
Having issues? You can contact us here