PDF(Pubmed)
Abstract：
BACKGROUND: Diagnostic errors in internal medicine are common. While cognitive errors have previously been identified to be the most common contributor to errors, very little is known about errors in specific fields of internal medicine such as endocrinology. This prospective, multicenter study focused on better understanding the causes of diagnostic errors made by general practitioners and internal specialists in the area of endocrinology.
METHODS: From August 2019 until January 2020, 24 physicians completed five endocrine cases on an online platform that simulated the diagnostic process. After each case, the participants had to state and explain why they chose their assumed diagnosis. The data gathering process as well as the participants\' explanations were quantitatively and qualitatively analyzed to determine the causes of the errors. The diagnostic processes in correctly and incorrectly solved cases were compared.
RESULTS: Seven different causes of diagnostic error were identified, the most frequent being misidentification (mistaking one diagnosis with a related one or with more frequent and similar diseases) in 23% of the cases. Other causes were faulty context generation (21%) and premature closure (17%). The diagnostic confidence did not differ between correctly and incorrectly solved cases (median 8 out of 10, p = 0.24). However, in incorrectly solved cases, physicians spent less time on the technical findings (such as lab results, imaging) (median 250 s versus 199 s, p < 0.049).
CONCLUSIONS: The causes for errors in endocrine case scenarios are similar to the causes in other fields of internal medicine. Spending more time on technical findings might prevent misdiagnoses in everyday clinical practice.
METHODS: From August 2019 until January 2020, 24 physicians completed five endocrine cases on an online platform that simulated the diagnostic process. After each case, the participants had to state and explain why they chose their assumed diagnosis. The data gathering process as well as the participants\' explanations were quantitatively and qualitatively analyzed to determine the causes of the errors. The diagnostic processes in correctly and incorrectly solved cases were compared.
RESULTS: Seven different causes of diagnostic error were identified, the most frequent being misidentification (mistaking one diagnosis with a related one or with more frequent and similar diseases) in 23% of the cases. Other causes were faulty context generation (21%) and premature closure (17%). The diagnostic confidence did not differ between correctly and incorrectly solved cases (median 8 out of 10, p = 0.24). However, in incorrectly solved cases, physicians spent less time on the technical findings (such as lab results, imaging) (median 250 s versus 199 s, p < 0.049).
CONCLUSIONS: The causes for errors in endocrine case scenarios are similar to the causes in other fields of internal medicine. Spending more time on technical findings might prevent misdiagnoses in everyday clinical practice.
摘要：
背景：内科诊断错误很常见。虽然认知错误以前被认为是错误的最常见原因，对内分泌学等内科特定领域的错误知之甚少。这个未来,多中心研究的重点是更好地了解内分泌学领域的全科医生和内科医生诊断错误的原因。
方法：从2019年8月到2020年1月，24名医生在模拟诊断过程的在线平台上完成了5例内分泌病例。在每个案例之后,参与者必须陈述并解释他们选择其假定诊断的原因.对数据收集过程以及参与者的解释进行了定量和定性分析，以确定错误的原因。比较了正确和错误解决的病例中的诊断过程。
结果：确定了七种不同的诊断错误原因，在23％的病例中，最常见的是错误识别（将一项诊断与相关疾病或更常见和类似的疾病误认为）。其他原因是上下文生成错误（21％）和过早闭合（17％）。正确和错误解决的病例之间的诊断置信度没有差异（中位数为8/10，p=0.24）。然而,在错误解决的案件中，医生花在技术发现上的时间较少(如实验室结果，成像)(中位数250秒对199秒，p<0.049)。
结论：内分泌病例中错误的原因与内科其他领域的原因相似。在技术发现上花费更多时间可能会防止日常临床实践中的误诊。
方法：从2019年8月到2020年1月，24名医生在模拟诊断过程的在线平台上完成了5例内分泌病例。在每个案例之后,参与者必须陈述并解释他们选择其假定诊断的原因.对数据收集过程以及参与者的解释进行了定量和定性分析，以确定错误的原因。比较了正确和错误解决的病例中的诊断过程。
结果：确定了七种不同的诊断错误原因，在23％的病例中，最常见的是错误识别（将一项诊断与相关疾病或更常见和类似的疾病误认为）。其他原因是上下文生成错误（21％）和过早闭合（17％）。正确和错误解决的病例之间的诊断置信度没有差异（中位数为8/10，p=0.24）。然而,在错误解决的案件中，医生花在技术发现上的时间较少(如实验室结果，成像)(中位数250秒对199秒，p<0.049)。
结论：内分泌病例中错误的原因与内科其他领域的原因相似。在技术发现上花费更多时间可能会防止日常临床实践中的误诊。
