Teaching for Reducing Diagnostic Errors

casepresentation*DEVENDRA MISHRA, # PIYUSH GUPTA AND TEJINDER SINGH
From Departments of Pediatrics, *Maulana Azad Medical College,and #University College of Medical Sciences, New Delhi; and Christian Medical College, Ludhiana, Punjab; India.
Correspondence to: Dr Tejinder Singh, Department of Pediatrics and Medical Education, Christian Medical College,
Ludhiana 141 008, India. [email protected]

Diagnostic errors, constituted by a missed, wrong, or delayed diagnosis detected later by additional tests or findings, are one of the most vexing issues in medicine. They are one of the commonest causes of patient-harm and also medical negligence claims.

Although a variety of constructs have been proposed to explain diagnostic errors, the complex interplay of cognitive- and system-factors that underlie these errors is rarely clear to the clinicians. In this write-up, we discuss the reasons for diagnostic errors and how medical students can be trained to avoid such errors.

The errors have been classified as Cognitive errors, System errors, and No-fault errors, and cognitive interventions to address each of these are detailed.

Improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Although, the individual physicians may be more comfortable in discussing the ‘system-faults’ rather than cognitive errors, which are apparently more personal, it is the cognitive aspect that is more amenable to educational interventions. Addressing diagnostic errors systematically will require a comprehensive approach; developing formal curricula to educate trainees about misdiagnoses is one such [68,69]. We hope that individual institutions and teachers will take the onerous responsibility of carrying out teaching-learning activities for reduction of diagnostic error, till such time professional or regulatory bodies develop such curricula.

Key words: Clinical reasoning; Cognitive errors; Diagnosis; Misdiagnosis-related harm.

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