Predictors of diagnostic accuracy and safe management in difficult diagnostic problems in family medicine

Med Decis Making. 2008 Sep-Oct;28(5):668-80. doi: 10.1177/0272989X08319958. Epub 2008 Jun 12.


Objective: To investigate the role of information gathering and clinical experience on the diagnosis and management of difficult diagnostic problems in family medicine.

Method: Seven diagnostic scenarios including 1 to 4 predetermined features of difficulty were constructed and presented on a computer to 84 physicians: 21 residents in family medicine, 21 family physicians with 1 to 3 y in practice, and 42 family physicians with >or=10 y in practice. Following the Active Information Search process tracing approach, participants were initially presented with a patient description and presenting complaint and were subsequently able to request further information to diagnose and manage the patient. Evidence-based scoring criteria for information gathering, diagnosis, and management were derived from the literature and a separate study of expert opinion.

Results: Rates of misdiagnosis were in accordance with the number of features of difficulty. Seventy-eight percent of incorrect diagnoses were followed by inappropriate management and 92% of correct diagnoses by appropriate management. Number of critical cues requested (cues diagnostic of any relevant differential diagnoses in a scenario) was a significant predictor of accuracy in 6 scenarios: 1 additional critical cue increased the odds of obtaining the correct diagnosis by between 1.3 (95% confidence interval [CI], 1.0-1.8) and 7.5 (95% CI, 3.2- 17.7), depending on the scenario. No effect of experience was detected on either diagnostic accuracy or management. Residents requested significantly more cues than experienced family physicians did.

Conclusions: Supporting the gathering of critical information has the potential to improve the diagnosis and management of difficult problems in family medicine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Clinical Competence / standards
  • Diagnosis, Differential*
  • Diagnostic Errors
  • England
  • Evidence-Based Medicine
  • Family Practice*
  • Female
  • Forecasting
  • Humans
  • Information Storage and Retrieval
  • Interviews as Topic
  • Male
  • Middle Aged
  • Safety Management*