Misleading one detail: a preventable mode of diagnostic error?
OBJECTIVE
Despite advances in our understanding of cognitive biases in clinical practice, little is known about correction or prevention of diagnostic errors. The presence of a single misleading detail may lead clinicians down a cognitive and actual path toward an incorrect diagnosis.


METHODS
In a large teaching hospital, we surveyed 51 attending doctors in internal medicine, presenting each with 10 clinical vignettes and soliciting their diagnosis of the condition leading to the presentation. Each of the 10 clinical cases included a single misleading detail.


RESULTS
This survey elicited a wrong diagnosis in 90% of cases, which was reduced to 30% when omitting the misleading detail from the vignette. Diagnostic accuracy did not improve by warning doctors about potentially misleading information. Asking doctors to identify a leading diagnostic detail and then to formulate an alternative diagnosis after omission of the detail, significantly reduced diagnostic error rate by nearly 50%.


CONCLUSIONS
Systematic re-examination of leading diagnostic clues may help to reduce errors in diagnosis.
Arzy
Shahar
S
Department of Neurology, Hadassah Hebrew University Hospital, Jerusalem, Israel. shahar.arzy@hcuge.ch
Brezis
Mayer
M
Khoury
Salim
S
Simon
Steven R
SR
Ben-Hur
Tamir
T
D003071:Cognition; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control*; D019538:Health Care Surveys; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine; D007557:Israel; D013663:Teaching / Q000379:methods*