Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental study
Abstract Background Diagnostic errors are a major cause of preventable patient harm. Studies suggest that presenting inaccurate diagnostic suggestions can cause errors in physicians’ diagnostic reasoning processes. It is common practice for general practitioners (GPs) to suggest a diagnosis when ref...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12909-022-03325-7 |
| _version_ | 1819209828213456896 |
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| author | J. Staal M. Speelman R. Brand J. Alsma L. Zwaan |
| author_facet | J. Staal M. Speelman R. Brand J. Alsma L. Zwaan |
| author_sort | J. Staal |
| collection | DOAJ |
| description | Abstract Background Diagnostic errors are a major cause of preventable patient harm. Studies suggest that presenting inaccurate diagnostic suggestions can cause errors in physicians’ diagnostic reasoning processes. It is common practice for general practitioners (GPs) to suggest a diagnosis when referring a patient to secondary care. However, it remains unclear via which underlying processes this practice can impact diagnostic performance. This study therefore examined the effect of a diagnostic suggestion in a GP’s referral letter to the emergency department on the diagnostic performance of medical interns. Methods Medical interns diagnosed six clinical cases formatted as GP referral letters in a randomized within-subjects experiment. They diagnosed two referral letters stating a main complaint without a diagnostic suggestion (control), two stating a correct suggestion, and two stating an incorrect suggestion. The referral question and case order were randomized. We analysed the effect of the referral question on interns’ diagnostic accuracy, number of differential diagnoses, confidence, and time taken to diagnose. Results Forty-four medical interns participated. Interns considered more diagnoses in their differential without a suggested diagnosis (M = 1.85, SD = 1.09) than with a suggested diagnosis, independent of whether this suggestion was correct (M = 1.52, SD = 0.96, d = 0.32) or incorrect ((M = 1.42, SD = 0.97, d = 0.41), χ2(2) =7.6, p = 0.022). The diagnostic suggestion did not influence diagnostic accuracy (χ2(2) = 1.446, p = 0.486), confidence, (χ2(2) = 0.058, p = 0.971) or time to diagnose (χ2(2) = 3.128, p = 0.209). Conclusions A diagnostic suggestion in a GPs referral letter did not influence subsequent diagnostic accuracy, confidence, or time to diagnose for medical interns. However, a correct or incorrect suggestion reduced the number of diagnoses considered. It is important for healthcare providers and teachers to be aware of this phenomenon, as fostering a broad differential could support learning. Future research is necessary to examine whether these findings generalize to other healthcare workers, such as more experienced specialists or triage nurses, whose decisions might affect the diagnostic process later on. Trial registration The study protocol was preregistered and is available online at Open Science Framework ( https://osf.io/7de5g ). |
| first_indexed | 2024-12-23T06:01:29Z |
| format | Article |
| id | doaj.art-2a565ab6932549d7974071fbad1f0f07 |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-12-23T06:01:29Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-2a565ab6932549d7974071fbad1f0f072022-12-21T17:57:39ZengBMCBMC Medical Education1472-69202022-04-012211710.1186/s12909-022-03325-7Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental studyJ. Staal0M. Speelman1R. Brand2J. Alsma3L. Zwaan4Erasmus University Medical Center Rotterdam, Institute of Medical Education ResearchErasmus University Medical Center Rotterdam, Institute of Medical Education ResearchIntensive Care Unit, Haaglanden Medical Center Den HaagDepartment of Internal Medicine, Erasmus University Medical Center RotterdamErasmus University Medical Center Rotterdam, Institute of Medical Education ResearchAbstract Background Diagnostic errors are a major cause of preventable patient harm. Studies suggest that presenting inaccurate diagnostic suggestions can cause errors in physicians’ diagnostic reasoning processes. It is common practice for general practitioners (GPs) to suggest a diagnosis when referring a patient to secondary care. However, it remains unclear via which underlying processes this practice can impact diagnostic performance. This study therefore examined the effect of a diagnostic suggestion in a GP’s referral letter to the emergency department on the diagnostic performance of medical interns. Methods Medical interns diagnosed six clinical cases formatted as GP referral letters in a randomized within-subjects experiment. They diagnosed two referral letters stating a main complaint without a diagnostic suggestion (control), two stating a correct suggestion, and two stating an incorrect suggestion. The referral question and case order were randomized. We analysed the effect of the referral question on interns’ diagnostic accuracy, number of differential diagnoses, confidence, and time taken to diagnose. Results Forty-four medical interns participated. Interns considered more diagnoses in their differential without a suggested diagnosis (M = 1.85, SD = 1.09) than with a suggested diagnosis, independent of whether this suggestion was correct (M = 1.52, SD = 0.96, d = 0.32) or incorrect ((M = 1.42, SD = 0.97, d = 0.41), χ2(2) =7.6, p = 0.022). The diagnostic suggestion did not influence diagnostic accuracy (χ2(2) = 1.446, p = 0.486), confidence, (χ2(2) = 0.058, p = 0.971) or time to diagnose (χ2(2) = 3.128, p = 0.209). Conclusions A diagnostic suggestion in a GPs referral letter did not influence subsequent diagnostic accuracy, confidence, or time to diagnose for medical interns. However, a correct or incorrect suggestion reduced the number of diagnoses considered. It is important for healthcare providers and teachers to be aware of this phenomenon, as fostering a broad differential could support learning. Future research is necessary to examine whether these findings generalize to other healthcare workers, such as more experienced specialists or triage nurses, whose decisions might affect the diagnostic process later on. Trial registration The study protocol was preregistered and is available online at Open Science Framework ( https://osf.io/7de5g ).https://doi.org/10.1186/s12909-022-03325-7Diagnostic errorClinical reasoningCognitive biasPatient safety |
| spellingShingle | J. Staal M. Speelman R. Brand J. Alsma L. Zwaan Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental study BMC Medical Education Diagnostic error Clinical reasoning Cognitive bias Patient safety |
| title | Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental study |
| title_full | Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental study |
| title_fullStr | Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental study |
| title_full_unstemmed | Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental study |
| title_short | Does a suggested diagnosis in a general practitioners’ referral question impact diagnostic reasoning: an experimental study |
| title_sort | does a suggested diagnosis in a general practitioners referral question impact diagnostic reasoning an experimental study |
| topic | Diagnostic error Clinical reasoning Cognitive bias Patient safety |
| url | https://doi.org/10.1186/s12909-022-03325-7 |
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