Trial One
Improving Medical Diagnosis
When a patient arrives at the emergency department, the correct diagnosis is critical to ensuring appropriate treatment.
Misdiagnosis can happen.
Hospital Emergency Departments are busy and chaotic environments and there is an increased risk that cognitive biases - the mental shortcuts we all use every day- will influence in clinicians’ decision making, leading to misdiagnosis, poor patient outcomes and even death.
The aim of this behaviour change trial was to test the effectiveness of a structured discussion between two clinicians and their independent diagnoses for reducing cognitive bias.
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The Rapid Diagnosis Discussion tool.
Patients presenting to the ED with abdominal pain were first examined by one doctor then independently reviewed by another doctor. The two doctors then had a prompted, short discussion about their working diagnoses before proceeding with patient management.
Question prompts were:
• ‘Are there any symptoms or signs that don’t fit? Any red flags?’
• ‘Are any additional tests/investigations needed or do you already have sufficient confidence in the diagnosis to proceed without them?’
• ‘Do we have all the relevant information about the patient?’
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Aided discussion can reduce misdiagnosis.
Patients presenting to the ED with abdominal pain were first examined by one doctor then independently reviewed by another doctor. The two doctors then had a prompted, short discussion about their working diagnoses before proceeding with patient management.
Patient persepctive
There were some cases in the RaDD trial where the final diagnosis was a more serious condition than the initial one, avoiding potentially catastrophic outcomes. The tool cannot only help to improve patient outcomes but also help to reduce costs across the health system.
VMIA perspective
“Misdiagnosis is a direct cause to a contributing factor of 30% of our medical indemnity claims. Using behavioural science, this trial developed a tool for doctors to navigate and mitigate some of the common challenges behind misdiagnosis. Initial results from the trial are promising, but further work needs to happen to assess its use in the future.”
Health service perspective
“Clinicians got an enormous amount of relief and confidence by having someone else also assess the patient and have a structured conversation about what their thoughts were”
Dr Paul Buntine, Emergency Doctor, Box Hill Emergency Department
Behavioural research perspective
This trial shows that a second opinion and brief peer discussions can alter a doctor’s working diagnosis by reducing cognitive bias. More research is needed to see if this works on other types of patients and in other settings, such as smaller emergency departments, wards or non-hospital environments. Studies are also needed to examine whether the savings of identifying misdiagnoses outweigh the costs.