When your employer pressures you to cram 30 patients into one day or to spend no more than 15 minutes on a visit, worrying you’ll make a mistake when providing at treatment is only normal.
Among the most common ways that NPs and PAs slip up are diagnostic errors. And to assess how often they happen, Medscape went right to the source in a recent poll. The survey asked 751 respondents (633 physicians, 118 NPs and PAs) how often they experience “diagnostic uncertainty” and/or believe they’ve made a “diagnostic error.” Medscape also probed into which processes prompt the most feelings of doubt — such as taking a patient’s history or performing an exam — and which aspects of the healthcare system drive the most errors — such as a lack of collaboration among clinicians or time constraints.
Overall, the research found NPs and PAs were slightly less confident in their diagnostic abilities than physicians. Roughly 17 percent of NPs and PAs believe they make diagnostic errors daily compared to 16.6 percent of physicians. (For context, previous research indicates that diagnostic errors occur in between 10 and 15 percent of patient interactions. That means if you see fewer than 10 patients a day, you probably don’t make an error every day. But if you see more than 10, you probably do.)
Similarly, 64 percent of NPs and PAs experience diagnostic uncertainty every day compared to 52 percent of physicians. Some 21 NPs and PAs experienced it once a week compared to 20 percent of physicians. Interestingly, neither group said they “never” experienced diagnostic uncertainty.
The PA/NP respondents reported experiences on par with physicians’ when addressing reasons for diagnostic errors. Both groups cited the same top three: a lack of feedback on diagnostic accuracy, time constraints and a culture that discourages disclosure of errors. Also, NPs, PAs and physicians all said they experience the most uncertainty when making the actual diagnosis, followed by when deciding what tests to order.
Another noteworthy finding: Diagnostic uncertainty varied greatly by specialty. Providers working in pediatrics believed they made diagnostic errors the least, with only 11 percent saying they happen every day. Providers working in emergency medicine believe they make diagnostic errors the most, with 26 percent reporting daily concern. Family medicine, general practice and internal medicine fell in the middle with 18 percent, 22 percent and 15 percent respectively citing daily errors.
How Often Are You Unsure of Diagnoses?, Medscape.
Improving Diagnosis in Health Care, National Academies of Sciences, Engineering and Medicine.