Physicians face diagnostic difficulties in primary care for a variety of reasons
Patient Safety and Quality
Missed, delayed and incorrect diagnoses lead to significant patient harm and wasted medical resources. Although physicians may be unaware of the diagnostic errors they make, they identified some of the difficulties they experience in the diagnostic process during primary care in a recent survey. The researchers surveyed primary care physicians in an integrated health system across 10 States in 2005. The survey asked about the extent and predictors of diagnostic difficulty among primary care physicians. Half of the 1,054 physicians who responded to the survey reported that more than 5 percent of their patients were difficult to diagnose. Physicians with more experience reported less diagnostic difficulty. Both inadequate time to process diagnostic information and insufficient guidance from subspecialists were correlated with diagnostic difficulty. Inadequate knowledge (19.9 percent) was the most commonly reported cognitive factor associated with diagnostic difficulty. The second most common factor was faulty detection or perception of diagnostic information (such as from history/exam/record review).
The respondents suggested several strategies for improvement that centered on physician workload. First, they recommended longer visit time with patients to allow for more thorough history and physical examination. They cited the need to reduce workload in order to have protected time to review patient results. Another suggestion was for more time for physicians to think carefully about difficult cases, and to perform "cognitive work." The study was supported in part by the Agency for Healthcare Research and Quality (HS17594).
See "Challenges of making a diagnosis in the outpatient setting: A multi-site survey of primary care physicians," by Urmimala Sarkar, M.D., M.P.H., Doug Bonacum, M.B.A., William Strull, M.D., and others in the BMJ Quality and Safety 21, pp. 641-648, 2012.