Do my feelings fit the diagnosis? Avoiding misdiagnoses in psychosomatic consultation services

Abstract

Objective: Misdiagnoses are a major concern with far-reaching consequences, which have rarely been studied systematically. Therefore, the present study evaluated factors causing misdiagnoses identified by psychosomatic consultation services.

Methods: Over a period of 5 years, all patients referred to the psychosomatic consultation services of a large university hospital were analyzed consecutively for misdiagnoses. We analyzed the reasons for suspecting a misdiagnosis through systematic introspection during peer supervision and evaluated the causes during semistructured interviews with the referring physician.

Results: In 165 psychosomatic consultations, 24 disorders were misdiagnosed (15%). The reasons for questioning the initial diagnoses were the consulting physician's feelings and thoughts resulting from the patients' inappropriate behavior during the consultation and unusual clinical features. In eight cases, the misdiagnosis resulted from availability bias, and in three cases each it resulted from confirmation bias, search satisfaction bias, and framing effect and attribution bias. However, lack of medical knowledge played only a minor role.

Conclusion: This study highlights the nonrational elements of the diagnostic process. In the context of psychosomatic consultation services, introspection and intuitive thought processes are helpful in identifying misdiagnoses. Self-satisfaction (availability bias) and overconfidence (confirmation bias) are most likely to result in misdiagnoses.

Keywords: cognitive bias; dual process theory; misdiagnosis; nonrational diagnostic process; psychosomatic consultation services; systematic introspection.