Diagnostic errors more common, costly and harmful than treatment mistakes

This is the headline for an important review paper in BMJ in Quality and Safety. The paper is a must read for everyone. As noted by the authors, diagnostic errors are more complex and open up a huge can worms relative to surgical and medication errors. Given that the review only looks at the worst cases, the extent of the problem is probably severely underestimated. The results are even more striking when we consider the increase in defensive medicine. Psychology, in collaboration with medicine, has a huge role to play here.

The full paper can be found at: BMJ Qual Saf doi:10.1136/bmjqs-2012-001550

A short synopsis of the main results can be found at: http://m.hopkinsmedicine.org/news/media/releases/diagnostic_errors_more_common_costly_and_harmful_than_treatment_mistakes

Can we measure physician performance?

Can we measure individual physician performance? Social scientists have known for quite some time that performance evaluation can actually depress motivation. SO the question can actually become, not can we, but should we?  Cassell and Jain, in an interesting JAMA viewpoint paper [JAMA, June 27, 2012—Vol 307, No. 24] tackle the issue directly and present many compelling arguments as to why individual performance systems are likely to decrease intrinsic motivation and increase extrinsic motivation. The authors argue for more meaningful patient-centered goals that are clearly communicated. Ultimately, the authors recommend for more group/team based incentives. In my opinion, they are talking sense, and the paper is worth a read. Their paper is an interesting counter point to the idea of physicians as homo-economicus.  

Are GPs buckling under time pressure?

The need for physicians to see more people in less time is a stressor. The reduction in resources in healthcare means that such trends are set to continue and probably worsen. In a recent paper in BMJ Open (of which I’m a co-author) using an experimental approach, we found that under time pressure, adherence to guidelines concerning history taking and advice giving is compromised [BMJ Open 2013;3:e002700. doi:10.1136/bmjopen-2013-002700]. The research also found that GPs were less compliant with guidelines on giving advice on lifestyle, especially, concerning smoking habits. We should be mindful of how efficiency and effectiveness can travel in opposite directions. 

Are GPs buckling under time pressure?

The need for physicians to see more people in less time is a stressor. The reduction in resources in healthcare means that such trends are set to continue and probably worsen. In a recent paper in BMJ Open (of which I’m a co-author) using an experimental approach, we found that under time pressure, adherence to guidelines concerning history taking and advice giving is compromised [BMJ Open 2013;3:e002700. doi:10.1136/bmjopen-2013-002700]. The research also found that GPs were less compliant with guidelines on giving advice on lifestyle, especially, concerning smoking habits. We should be mindful of how efficiency and effectiveness can travel in opposite directions.