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Kunitomo K, Gupta A, Harada T, Watari T. The Big Three diagnostic errors through reflections of Japanese internists. Diagnosis (Berl) 2024; 11:273-282. [PMID: 38501928 DOI: 10.1515/dx-2023-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES To analyze the Big Three diagnostic errors (malignant neoplasms, cardiovascular diseases, and infectious diseases) through internists' self-reflection on their most memorable diagnostic errors. METHODS This secondary analysis study, based on a web-based cross-sectional survey, recruited participants from January 21 to 31, 2019. The participants were asked to recall the most memorable diagnostic error cases in which they were primarily involved. We gathered data on internists' demographics, time to error recognition, and error location. Factors causing diagnostic errors included environmental conditions, information processing, and cognitive bias. Participants scored the significance of each contributing factor on a Likert scale (0, unimportant; 10, extremely important). RESULTS The Big Three comprised 54.1 % (n=372) of the 687 cases reviewed. The median physician age was 51.5 years (interquartile range, 42-58 years); 65.6 % of physicians worked in hospital settings. Delayed diagnoses were the most common among malignancies (n=64, 46 %). Diagnostic errors related to malignancy were frequent in general outpatient settings on weekdays and in the mornings and were not identified for several months following the event. Environmental factors often contributed to cardiovascular disease-related errors, which were typically identified within days in emergency departments, during night shifts, and on holidays. Information gathering and interpretation significantly impacted infectious disease diagnoses. CONCLUSIONS The Big Three accounted for the majority of cases recalled by Japanese internists. The most relevant contributing factors were different for each of the three categories. Addressing these errors may require a unique approach based on the disease associations.
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Affiliation(s)
- Kotaro Kunitomo
- Department of General Medicine, 37028 NHO Kumamoto Medical Center , Kumamoto, Japan
| | - Ashwin Gupta
- Medicine Service, 20034 Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, MI, USA
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Taku Harada
- Department of General Medicine, 83943 Nerima Hikarigaoka Hospital , Nerima-ku, Tokyo, Japan
| | - Takashi Watari
- Medicine Service, 20034 Veterans Affairs Ann Arbor Healthcare System , Ann Arbor, MI, USA
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of General Medicine, 83943 Nerima Hikarigaoka Hospital , Nerima-ku, Tokyo, Japan
- General Medicine Center, Shimane University Hospital, Izumo shi, Shimane, Japan
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Mioramalala S, Mroueh L, Bruand PE, Raharinivo MM, Rafanomezantsoa RM, Gérard D, Ratsimbasoa A, Preux PM, Boumédiène F. Effects of an intervention program to improve mental health and epilepsy care in Madagascar. Compr Psychiatry 2024; 132:152484. [PMID: 38626596 DOI: 10.1016/j.comppsych.2024.152484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Despite the high prevalence of mental disorders and epilepsy in low- and middle-income countries, nearly 80% of patients are not treated. In Madagascar, initiatives to improve access to epilepsy and mental health care, including public awareness and training of general practitioners (GPs), were carried out between 2013 and 2018. Our study's main objective was to assess the effectiveness of these initiatives, two to five years post-intervention. METHODS This quasi-experimental study (intervention vs. control areas) included five surveys assessing: general population's Knowledge Attitudes and Practices (KAP), GPs' KAP , number of epilepsy and mental health consultations at different levels of the healthcare system, diagnostic accuracy, and treatments' availability. OUTCOMES In the general population, KAP scores were higher in intervention areas for epilepsy (11.4/20 vs. 10.3/20; p = 0.003). For mental disorders, regardless of the area, KAP scores were low, especially for schizophrenia (1.1/20 and 0.1/20). Among GPs, KAP scores were higher in intervention areas for schizophrenia (6.0/10 vs. 4.5/10; p = 0.008) and epilepsy (6.9/10 vs. 6.2/10; p = 0.044). Overall, there was a greater proportion of mental health and epilepsy consultations in intervention areas (4.5% vs 2.3%). Although low, concordance between GPs' and psychiatrists' diagnoses was higher in intervention areas. There was a greater variety of anti-epileptic and psychotropic medications available in intervention areas. INTERPRETATION This research has helped to better understand the effectiveness of initiatives implemented in Madagascar to improve epilepsy and mental health care and to identify barriers which will need to be addressed. FUNDING Sanofi Global Health, as part of the Fight Against STigma Program.
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Affiliation(s)
- Sedera Mioramalala
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; Université de Fianarantsoa, Faculté des Sciences, ED GEOCHIMED, Chimie Médicinale, Fianarantsoa, Madagascar
| | - Lara Mroueh
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Emile Bruand
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | | | | | - Daniel Gérard
- Ville Evrard Public Hospital, Department 93G10, Neuilly sur Marne, France
| | - Arsène Ratsimbasoa
- Université de Fianarantsoa, Faculté de Médecine, Fianarantsoa, Madagascar
| | - Pierre-Marie Preux
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Farid Boumédiène
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
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Harada Y, Otaka Y, Katsukura S, Shimizu T. Effect of contextual factors on the prevalence of diagnostic errors among patients managed by physicians of the same specialty: a single-centre retrospective observational study. BMJ Qual Saf 2024; 33:386-394. [PMID: 36690471 DOI: 10.1136/bmjqs-2022-015436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND There has been growing recognition that contextual factors influence the physician's cognitive processes. However, given that cognitive processes may depend on the physicians' specialties, the effects of contextual factors on diagnostic errors reported in previous studies could be confounded by difference in physicians. OBJECTIVE This study aimed to clarify whether contextual factors such as location and consultation type affect diagnostic accuracy. METHODS We reviewed the medical records of 1992 consecutive outpatients consulted by physicians from the Department of Diagnostic and Generalist Medicine in a university hospital between 1 January and 31 December 2019. Diagnostic processes were assessed using the Revised Safer Dx Instrument. Patients were categorised into three groups according to contextual factors (location and consultation type): (1) referred patients with scheduled visit to the outpatient department; (2) patients with urgent visit to the outpatient department; and (3) patients with emergency visit to the emergency room. The effect of the contextual factors on the prevalence of diagnostic errors was investigated using logistic regression analysis. RESULTS Diagnostic errors were observed in 12 of 534 referred patients with scheduled visit to the outpatient department (2.2%), 3 of 599 patients with urgent visit to the outpatient department (0.5%) and 13 of 859 patients with emergency visit to the emergency room (1.5%). Multivariable logistic regression analysis showed a significantly higher prevalence of diagnostic errors in referred patients with scheduled visit to the outpatient department than in patients with urgent visit to the outpatient department (OR 4.08, p=0.03), but no difference between patients with emergency and urgent visit to the emergency room and outpatient department, respectively. CONCLUSION Contextual factors such as consultation type may affect diagnostic errors; however, since the differences in the prevalence of diagnostic errors were small, the effect of contextual factors on diagnostic accuracy may be small in physicians working in different care settings.
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Affiliation(s)
- Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yumi Otaka
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Shinichi Katsukura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
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Schooren L, Oberhoff G, Schipper S, Koch A, Kroh A, Olde Damink S, Ulmer TF, Neumann UP, Alizai PH, Schmitz SM. Students and physicians differ in perception of quality of life in patients with tumors of the upper gastrointestinal tract. Sci Rep 2024; 14:9460. [PMID: 38658620 PMCID: PMC11043386 DOI: 10.1038/s41598-024-59350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Health-related quality of life (HRQoL) has recently gained importance as treatment options for tumors of the upper GI tract lead to improved long-term survival. HRQoL is often estimated by physicians even though their reliability and the impact of outside factors such as contact time and level of medical education is unclear. Therefore, in this study we investigated the correlation between physicians', students', and patients' assessment of HRQoL. 54 patients presenting with tumors of the upper GI tract were included and asked to fill out the standardized HRQoL questionnaires EORTC QLQ-C30 and QLQ-OG25. Attending physicians and medical students filled out the same questionnaires through estimation of patients' HRQoL. Correlation was assessed through Pearson's and Kendall's τb coefficients. Physicians' and patients' assessments correlated for one out of six of the functional and a third of the symptom scores. Students' and patients' assessments correlated for one third of the functional and two thirds of the symptom scores. Students tended to underestimate patients' symptom burden while physicians tended to overestimate it. Physicians failed to correctly assess several pathognomonic symptoms in this study. Students showed higher correlation with patients' symptoms than physicians. Even so, this adds to mounting evidence that shows the benefit of using patient-reported outcomes as a gold standard regarding HRQoL.
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Affiliation(s)
- Lena Schooren
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Grace Oberhoff
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sandra Schipper
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Trauma and Reconstructive Sugery, BG Klinikum Bergmanntrost, 06112, Halle, Germany
| | - Alexander Koch
- Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Steven Olde Damink
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Tom F Ulmer
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulf P Neumann
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Patrick H Alizai
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Klinik für Allgemein- und Viszeralchirurgie, Gemeinschaftskrankenhaus Bonn, Prinz-Albert-Straße 40, 53113, Bonn, Germany
| | - Sophia M Schmitz
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Yamashita S, Tago M, Tokushima M, Tokushima Y, Hirakawa Y, Aihara H, Katsuki NE, Fujiwara M, Oda Y. Effects of a 60-Minute Lecture About Diagnostic Errors for Medical Students: A Single-Center Interventional Study. Cureus 2024; 16:e56117. [PMID: 38618404 PMCID: PMC11014750 DOI: 10.7759/cureus.56117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION The danger of diagnostic errors exists in daily medical practice, and doctors are required to avoid such errors as much as possible. Although various factors, including cognitive, system-related, and patient-related factors, are involved in the occurrence of diagnostic errors, the percentage of doctors with insufficient medical knowledge among those factors is extremely low. Therefore, lectures on diagnostic errors might also be useful for medical students without experience working as doctors. This study investigated whether a 60-minute lecture on diagnostic errors would enable Japanese medical students to consider the factors involved in diagnostic errors and how their perceptions of diagnostic errors change. METHODS AND MATERIALS This single-center interventional study was conducted in October 2022 among fourth-year medical students at the Faculty of Medicine, Saga University. A questionnaire survey was conducted before and immediately after the lecture to investigate changes in the perceptions of medical students regarding diagnostic errors. One mock case question was given on an exam the day after the lecture, and the number of responses to cognitive biases and system-related and patient-related factors involved in diagnostic errors were calculated. RESULTS A total of 83 students were analyzed. After the lecture, medical students were significantly more aware of the existence of the concept of diagnostic error, the importance of learning about it, their willingness to continue learning about it, and their perception that learning about diagnostic errors improves their clinical skills. They were also significantly less likely to feel blame or shame over diagnostic errors. The mean numbers of responses per student for cognitive bias, system-related factors, and patient-related factors were 1.9, 3.4, and 0.9, respectively. The mean number of responses per student for all factors was 5.6. CONCLUSION A 60-minute lecture on diagnostic errors among medical students is beneficial because it significantly changes their perception of diagnostic errors. The results of the present study also suggest that lectures may enable Japanese medical students to consider the factors involved in diagnostic errors.
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Affiliation(s)
- Shun Yamashita
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, JPN
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Midori Tokushima
- Saga Medical Career Support Center, Saga University Hospital, Saga, JPN
| | | | - Yuka Hirakawa
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Motoshi Fujiwara
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Yasutomo Oda
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, JPN
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Watari T, Mizuno K, Sakaguchi K, Shimada Y, Tanimoto Y, Nakano Y, Kono K, Tokuda Y. Gender Inequality Improvement in Medical School Admissions in Japan. J Womens Health (Larchmt) 2024; 33:339-344. [PMID: 37943626 DOI: 10.1089/jwh.2023.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Purpose: To investigate the effects of gender discrimination in Japan's medical school admission process and to assess whether the situation has improved since the disclosure of such discrimination in 2018. Materials and Methods: A cross-sectional study was conducted using secondary data from the Ministry of Education, Culture, Sports, Science, and Technology. The proportions of male and female applicants vis-à-vis all successful candidates admitted from 2016 to 2021 were analyzed; four medical schools were found to be systematically guilty of discriminatory admission practices. Acceptance rate ratios (ARRs) were estimated, and difference-in-differences (DID) analysis was used to examine the differences in ARRs between the two groups-the 4 and 75 medical schools that were and were not reported, respectively-in the predisclosure (2016-2018) and postdisclosure (2019-2021) periods. Results: Female applicants were subjected to discriminatory admission practices at the four reported medical schools in the predisclosure period. However, postdisclosure, those four medical schools had higher female than male acceptance rates in all 3 years. DID analysis revealed a statistically significant estimated average treatment effect on the treated of 0.25148 (95% confidence interval [0.00455-0.49840]), indicating a 0.25-point increase in ARRs relative to the other 75 medical schools. Conclusions: Discriminatory practices against female applicants have decreased since the disclosure in 2018, with the acceptance rate of female students exceeding that of male students for the first time in 2021. In response to these findings, we propose recommendations to further promote gender equality in medicine.
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Affiliation(s)
- Takashi Watari
- General Medicine Center, Shimane University Hospital, Shimane, Japan
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kotoko Mizuno
- Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kota Sakaguchi
- General Medicine Center, Shimane University Hospital, Shimane, Japan
| | - Yuura Shimada
- Faculty of Medicine, Shimane University, Shimane, Japan
| | | | | | - Kaori Kono
- Post Clinical Training Center, Shonan Atsugi Hospital, Kanagawa, Japan
| | - Yasuharu Tokuda
- Muribushi Project for Okinawa Residency Programs, Okinawa, Japan
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Watari T, Gupta A, Amano Y, Tokuda Y. Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey. Intern Med 2024; 63:221-229. [PMID: 37286507 PMCID: PMC10864084 DOI: 10.2169/internalmedicine.1494-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/23/2023] [Indexed: 06/09/2023] Open
Abstract
Objective The etiologies of diagnostic errors among internal medicine physicians are unclear. To understand the causes and characteristics of diagnostic errors through reflection by those involved in them. Methods We conducted a cross-sectional study using a web-based questionnaire in Japan in January 2019. Over a 10-day period, a total of 2,220 participants agreed to participate in the study, of whom 687 internists were included in the final analysis. Participants were asked about their most memorable diagnostic error cases, in which the time course, situational factors, and psychosocial context could be most vividly recalled and where the participant provided care. We categorized diagnostic errors and identified contributing factors (i.e., situational factors, data collection/interpretation factors, and cognitive biases). Results Two-thirds of the identified diagnostic errors occurred in the clinic or emergency department. Errors were most frequently categorized as wrong diagnoses, followed by delayed and missed diagnoses. Errors most often involved diagnoses related to malignancy, circulatory system disorders, or infectious diseases. Situational factors were the most cited error cause, followed by data collection factors and cognitive bias. Common situational factors included limited consultation during office hours and weekends and barriers that prevented consultation with a supervisor or another department. Conclusion Internists reported situational factors as a significant cause of diagnostic errors. Other factors, such as cognitive biases, were also evident, although the difference in clinical settings may have influenced the proportions of the etiologies of the errors that were observed. Furthermore, wrong, delayed, and missed diagnoses may have distinctive associated cognitive biases.
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Affiliation(s)
- Takashi Watari
- General Medicine Center, Shimane University Hospital, Japan
- Medicine Service, VA Ann Arbor Healthcare System, USA
- Department of Medicine, University of Michigan Medical School, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, USA
- Department of Medicine, University of Michigan Medical School, USA
| | - Yu Amano
- Faculty of Medicine, Shimane University, Japan
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Wilson S, Rixon A, Brown C. Non-clinical intuitions and adaptive heuristics in emergency care: A scoping review. Int Emerg Nurs 2023; 71:101371. [PMID: 37866122 DOI: 10.1016/j.ienj.2023.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Across a range of fields, including healthcare, heuristics are typically conceived as a source of bias and systematic error. However, research across the psychological and management sciences shows that intuition and heuristics are also vital sources of adaptive decision strategies, especially in complex, uncertain environments. The complexity of the emergency care environment marks this environment as one in which non-clinical intuitions and heuristics are likely to emerge and function as adaptive decision strategies. The aim of this study was to map and contextualize what is known about leadership and non-clinical intuitions and heuristics in emergency care. METHODS Based on a systematic search of the Pubmed, Scopus, Web of Science, MEDLINE and CINAHL electronic databases, we conducted a scoping review to map what is known about leadership and non-clinical intuitions and adaptive heuristics in emergency care. RESULTS Of the 1219 articles retrieved, 9 met the inclusion criteria. Our review revealed four key findings. First, intuitions are used to make judgments about patients, caring for patients, and coordinating with colleagues. Second, although non-clinical intuitions are documented, non-clinical heuristics are rarely studied. Third, the literature is focused on nurses and silent on the use of non-clinical intuition and heuristics among medical doctors. Finally, professional cultures influence clinicians' use of intuitive sense- and decision-making. CONCLUSION This review highlights the dearth of research into non-clinical intuitions and heuristics in emergency care. Understood in the context of insights from the psychological and management sciences about intuitions and 'smart' heuristics as adaptive decision strategies, our findings point to new frontiers of research into leadership in emergency care.
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Affiliation(s)
- Samuel Wilson
- Swinburne Business School, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Andrew Rixon
- Griffith Business School, Griffith University, Gold Coast, Queensland, Australia.
| | - Cornelia Brown
- Swinburne Business School, Swinburne University of Technology, Melbourne, Victoria, Australia
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Alyami H. A Case of Panic Disorder Misdiagnosed as Epilepsy for 9 Years in a Young Male. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:175-177. [PMID: 37252019 PMCID: PMC10211418 DOI: 10.4103/sjmms.sjmms_313_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/20/2022] [Accepted: 03/02/2023] [Indexed: 05/31/2023]
Abstract
Panic disorder can be misdiagnosed as epilepsy and vice versa, which, in turn, can impact the patient, their family, and the healthcare system. Here, we describe a rare case of a 22-year-old male with a 9-year history of misdiagnosed drug-resistant epilepsy. On presentation to our hospital, the patient's physical examination and other investigations were unremarkable. The attacks were reported to last for about 5-10 minutes and were related to interfamilial distress. He reported feeling anxious about having an attack, experiencing palpitations and sweating before and during episodes, feeling chest tightness, derealization, and fearing loss of control, based on which a diagnosis of panic disorder was made. The patient was treated with 12 sessions of cognitive behavioral therapy, following which all his antiepileptic medications were stopped over 8 weeks. The dose of sertraline was increased and maintained at 200 mg once daily and was gradually stopped after 6 months of remission. This case highlights that panic disorder should be considered as a differential diagnosis of epilepsy. This can be done through a cross-specialty referral, especially given that the clinical manifestations of hyperventilation syndrome can be diagnosed differently by neurologists, psychiatrists, and other specialists.
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Affiliation(s)
- Hussain Alyami
- Department of Internal Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
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10
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Kunitomo K, Harada T, Watari T. Cognitive biases encountered by physicians in the emergency room. BMC Emerg Med 2022; 22:148. [PMID: 36028810 PMCID: PMC9414136 DOI: 10.1186/s12873-022-00708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/12/2022] [Indexed: 11/26/2022] Open
Abstract
Background Diagnostic errors constitute an important medical safety problem that needs improvement, and their frequency and severity are high in emergency room settings. Previous studies have suggested that diagnostic errors occur in 0.6-12% of first-time patients in the emergency room and that one or more cognitive factors are involved in 96% of these cases. This study aimed to identify the types of cognitive biases experienced by physicians in emergency rooms in Japan. Methods We conducted a questionnaire survey using Nikkei Medical Online (Internet) from January 21 to January 31, 2019. Of the 159,519 physicians registered with Nikkei Medical Online when the survey was administered, those who volunteered their most memorable diagnostic error cases in the emergency room participated in the study. EZR was used for the statistical analyses. Results A total of 387 physicians were included. The most common cognitive biases were overconfidence (22.5%), confirmation (21.2%), availability (12.4%), and anchoring (11.4%). Of the error cases, the top five most common initial diagnoses were upper gastrointestinal disease (22.7%), trauma (14.7%), cardiovascular disease (10.9%), respiratory disease (7.5%), and primary headache (6.5%). The corresponding final diagnoses for these errors were intestinal obstruction or peritonitis (27.3%), overlooked traumas (47.4%), other cardiovascular diseases (66.7%), cardiovascular disease (41.4%), and stroke (80%), respectively. Conclusions A comparison of the initial and final diagnoses of cases with diagnostic errors shows that there were more cases with diagnostic errors caused by overlooking another disease in the same organ or a disease in a closely related organ. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00708-3.
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Affiliation(s)
- Kotaro Kunitomo
- Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan
| | - Taku Harada
- Department of General Medicine, Koto Toyosu Hospital, Tokyo, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University, 89-1, Enya-cho, Izumo shi, Shimane, 693-8501, Japan. .,Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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