Engage the Patient
Indeed, one might think that the trickiest diagnoses are those in which physicians make the most mistakes, but that’s not the case. “We’re more prone to make these errors when we’re close to home, when we’re in our comfort zone,” Dr. Shah said. “We’re less likely to do so when we’re in uncharted waters because we are usually hyperaware in these situations.”
Explore This IssueSeptember 2014
That’s because physicians are more likely to double-check things when they’re uncertain. They’re more likely to follow up to get new information and are more open to changing their mind about a diagnosis. Double-checking and following up are signs of rational decision-making.
“Making a list of differential diagnoses is OK,” said Adam Folbe, MD, associate professor and director of special projects for the department of otolaryngology-head and neck surgery at Wayne State University School of Medicine in Detroit. “And it’s OK to include the patient in your uncertainty.” That might mean talking through the possibilities and asking patients to be partners in the process, ready to inform the physician of any change in status.
In a 2014 study, Dr. Folbe and his colleagues studied 78 pediatric otolaryngology cases that ended in litigation (Laryngoscope [published online ahead of print March 7, 2014]. doi: 10.1002/lary.24663). Misdiagnosis or failure to diagnose in a timely manner were factors in 41% of the cases.
Cultivating good relationships with patients can protect physicians against lawsuits, Dr. Folbe said, something he talks a lot about with his trainees. Yes, it might take a little more time, but “spending two minutes on informed consent earns trust and saves you in the long run,” he said. “Communication is key.”
Dr. Graber agreed, advising physicians to make patients partners in their own care. Physicians should think out loud: “Here’s what I think is going on, but you need to let me know how things play out.” And then follow up. “Patients can play such an important role in this game,” he said.
—Rahul Shah, MD
Review Your Work
In addition to learning about the traps of intuitive decision-making, physicians could surely benefit from reviewing their own work. Dr. Folbe is a “big fan” of morbidity and mortality reports. His group conducts these every six weeks, but, he said, “I think it’s missing in private practice.”