Background
Diagnostic error
Clinical reasoning
Factors associated with the diagnostic process in PC
Methods
Study design
Selection of centres
Study subjects
Sample size
Variables
Independent variables | Dependent variables | |||
---|---|---|---|---|
Physician | Setting | Patient | Suboptimal cognitive acts | Use of heuristics |
Age/Sex | Number of patients on list | Age/Sex | Lapses | Representativeness |
Years of experience | Number of patients attended | Nationality | Slips | Availability |
Speciality | Type of consultation | Profession | Mistakes | Anchoring and adjustment |
CME related to dyspnoea | Socioeconomic background | Education | Violations | |
Career level | Hospital referral | Employment | ||
Workload | Access to electronic medical record during physician-patient encounter | Morbidity | ||
Fatigue |
Study period
Data collection
PHASE 1. Record of the diagnostic process (provided by the physician)
Variable | Headland | When it is filled out | Explanation |
---|---|---|---|
1. Evaluation Of first diagnosis | |||
Diagnosis | First diagnostic impression | After reason for consultation described | Possible use of representativeness heuristic (“Of which disease is this specific episode of dyspnoea representative?”) |
Differential diagnosis (3 possible diagnoses identified in order of likelihood) | After the medical history is taken and physical examination is performed | Possible use of availability heuristic (diagnostic possibilities that come to the physician’s mind at the time of diagnosis) | |
Diagnosis | After the differential diagnosis | ||
Last 2 digits of patient’s social security number | After diagnosis | Possible use of anchoring and adjustment heuristic in estimation of the likelihood of the diagnosis being correct | |
Likelihood that the proposed diagnosis is correct (%) | After recording the last 2 digits of the patient’s social security number | ||
Context | Subjective workload | During consultation | Identification of specific situational factors during the consultation that could influence the diagnostic process, in terms of both use of heuristics and performance of suboptimal cognitive acts/errors |
Perceived subjective mental workload (adapted from NASA-TLX | During consultation | Evaluation of aspects of mental demand, physical demand, performance, effort and frustration | |
Adaptation of the Spanish version of the Swedish Occupational Fatigue Inventory (SOFI) | During consultation | Evaluation of work-related fatigue | |
Characteristics of the encounter between physician and patient:
| During consultation | Characteristics of the encounter | |
• Consultation type | |||
• Number of patients attended | |||
• Patient’s number in the order of patients attended | |||
• Consultation delay | |||
Relationship with the patient over time:
| During consultation | Longitudinality (capacity to provide care to patients over time) | |
• Time physician has been providing care for the patient | |||
• Time physician has been providing care for the same patient list | |||
• Number of previous visits by the patient in the last year | |||
• Date of last visit |
Variable | Headland | When it is filled out | Explanation |
---|---|---|---|
1. Evaluation Of final diagnosis | |||
- Final diagnosis confirmed | When final diagnosis of underlying cause of dyspnoea is made | Possible use of availability heuristic (diagnostic possibilities that come to the physician’s mind at the time of diagnosis) when the hypotheses are compared with the final diagnosis | |
- Time since first visit | |||
- Number of visits | |||
2. AUDIT | |||
Medical history | Personal and family history | After diagnosis is confirmed | Evaluation of accuracy of diagnosis |
Characteristics of dyspnoea | |||
Accompanying symptoms | |||
Physical examination | |||
Further tests | |||
Appropriateness of diagnostic process | |||
Performance of suboptimal cognitive acts | Identification of error type (slip, lapse, mistake, violation) | Evaluation of existence of suboptimal cognitive act | |
Identification of diagnostic error | Stage in which it occurs | Evaluation of the existence of an error and its consequences | |
Existence of misdiagnosis-related damage and damage type | |||
Possibility of damage prevention |