Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences.

Norbert Donner-Banzhoff; Beate Müller; Martin Beyer; Jörg Haasenritter; Carola Seifart

Study

Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences.

November 13, 2019

Donner-Banzhoff N, Müller B, Beyer M, et al. Diagnosis (Berl). 2019;7(2):115-121.

View more articles from the same authors.

This qualitative study examined primary care providers experience with missed diagnoses. After reviewing cases involving a missed diagnosis, clinicians proposed both analytical and intuitive changes to their clinical decision-making, which could result in lower thresholds for referrals or additional diagnostic testing.

PubMed citation

Available at

Related Resources From the Same Author(s)

Regret among primary care physicians: a survey of diagnostic decisions.

April 15, 2020

Improving critical incident reporting in primary care through education and involvement.

October 16, 2019

Strength of safety measures introduced by medical practices to prevent a recurrence of patient safety incidents: an observational study.

September 7, 2022

Patients' and healthcare workers' perceptions of a patient safety advisory.

October 19, 2011

Assessing patients' perceptions of safety culture in the hospital setting: development and initial evaluation of the patients' perceptions of safety culture scale.

February 28, 2018

Blackbox error management: how do practices deal with critical incidents in everyday practice? A qualitative interview study.

December 13, 2023

Characteristics of critical incident reporting systems in primary care: an international survey.

January 19, 2022

Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review.

November 28, 2018

"Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams.

February 19, 2020

"It's like two worlds apart": an analysis of vulnerable patient handover practices at discharge from hospital.

November 21, 2012

"Every error counts": a web-based incident reporting and learning system for general practice.

August 20, 2008

Causes of errors in the electrocardiographic diagnosis of atrial fibrillation by physicians.

March 14, 2007

Root causes of adverse drug events in hospitals and artificial intelligence capabilities for prevention.

May 5, 2021

Racism and electronic health records (EHRs): perspectives for research and practice.

April 12, 2023

Interventions into reliability-seeking health care organizations: a systematic review of their goals and measuring methods.

November 30, 2022

Influence of perceived difficulty of cases on student osteopaths' diagnostic reasoning: a cross sectional study.

January 31, 2018

Patients' negative experiences with health care settings brought to light by formal complaints: a qualitative metasynthesis.

September 27, 2023

Relationships of multitasking, physicians' strain, and performance: an observational study in ward physicians.

March 6, 2013

Burnout in mental health professionals: a systematic review and meta-analysis of prevalence and determinants.

December 12, 2018

Building bridges: future directions for medical error disclosure research.

July 24, 2013

Hospital complications: linking payment reduction to preventability.

May 6, 2009

When illegitimate tasks threaten patient safety culture: a cross-sectional survey in a tertiary hospital.

October 11, 2023

A transactional "second-victim" model—experiences of affected healthcare professionals in acute-somatic inpatient settings: a qualitative metasynthesis.

April 11, 2018

Preventable adverse events in obstetrics: systemic assessment of their incidence and linked risk factors.

February 16, 2022

Organizational resilience as paradox management: a systematic review of the literature.

January 24, 2024

Patient safety. Factors for and perceived consequences of nursing errors by nursing staff in home care services.

March 3, 2021

Hospital doctors' workflow interruptions and activities: an observation study.

March 16, 2011

Work conditions, mental workload and patient care quality: a multisource study in the emergency department.

October 14, 2015

The association of workflow interruptions and hospital doctors' workload: a prospective observational study.

May 2, 2012

Critical incident stress management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare.

October 1, 2014

Safety and efficiency of a new generic package labelling: a before and after study in a simulated setting.

May 17, 2017

In situ simulation: a strategy to restore patient safety in intensive care units after the COVID-19 pandemic?

February 8, 2023

Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial.

January 8, 2014

Errors in nurse-led triage: an observational study.

December 2, 2020

Interprofessional teamwork and team interventions in chronic care: a systematic review.

March 16, 2016

Communication patterns during routine patient care in a pediatric intensive care unit: the behavioral impact of in situ simulation.

May 11, 2022

Reducing preventable adverse events in obstetrics by improving interprofessional communication skills--results of an intervention study.

March 1, 2023

ASHP guidelines on preventing medication errors in hospitals.

October 17, 2018

Assessing distractors and teamwork during surgery: developing an event-based method for direct observation.

October 29, 2014

Patient safety in home care: a multicenter cross-sectional study about medication errors and medication management of nurses.

May 18, 2022

Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics.

April 22, 2009

Implementation of a comprehensive unit-based safety program to reduce surgical site infections in cesarean delivery.

April 22, 2020

The husband's story: from tragedy to learning and action.

June 10, 2015

May 5, 2021

Indicators for implementation outcome monitoring of reporting and learning systems in hospitals: an underestimated need for patient safety.

May 4, 2022

Thinking ethically about medical mistakes.

March 13, 2013

National survey on the effect of oncology drug shortages on cancer care.

April 10, 2013

Errors in palliative care: kinds, causes, and consequences: a pilot survey of experiences and attitudes of palliative care professionals.

November 28, 2012

Implementation of an online reporting system to identify unprofessional behaviors and mistreatment directed at trainees at an academic medical center.

December 21, 2022

Failure events in transition of care for surgical patients.

March 5, 2014

Interventions to improve communication at hospital discharge and rates of readmission: a systematic review and meta-analysis.

September 29, 2021

Six steps from head to hand: a simulator based transfer oriented psychological training to improve patient safety.

February 7, 2007

Organizational culture: an important context for addressing and improving hospital to community patient discharge.

March 6, 2013

The randomized AMBORA trial: impact of pharmacological/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents.

April 21, 2021

Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study.

July 19, 2023

Chemotherapy patients' perceptions of drug administration safety.

June 2, 2010

A model framework for patient safety training in chiropractic: a literature synthesis.

September 9, 2009

What's that sound? Managing alarm fatigue.

September 24, 2014

Use of heuristics during the clinical decision process from family care physicians in real conditions.

October 6, 2021

IT-CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety.

November 2, 2016

Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial.

November 30, 2022

Drug dosing error with drops – severe clinical course of codeine intoxication in twins.

November 5, 2008

Medical error—the third leading cause of death in the US.

May 11, 2016

After Mid Staffordshire: from acknowledgement, through learning, to improvement.

August 27, 2014

Parental involvement in the preoperative surgical safety checklist is welcomed by both parents and staff.

July 2, 2014

Making hospital care safer and better: the structure-process connection leading to adverse events.

May 4, 2005

Postdischarge adverse events among neonates admitted to the neonatal intensive care unit.

September 7, 2022

Medication errors in the care transition of trauma patients

December 18, 2019

Situation, background, assessment, and recommendation–guided huddles improve communication and teamwork in the emergency department.

December 16, 2015

Clinical decision support in the era of artificial intelligence.

November 21, 2018

Improved incident reporting following the implementation of a standardized emergency department peer review process.

June 11, 2014

Medicines management support to older people: understanding the context of systems failure.

August 6, 2014

Investigating the impact of cognitive bias in nursing documentation on decision-making and judgement.

April 20, 2022

Impact of intensive care unit discharge time on patient outcome.

January 17, 2007

The development and implementation of cognitive aids for critical events in pediatric anesthesia: the Society for Pediatric Anesthesia Critical Events Checklists.

March 15, 2017

Design and reliability of a specific instrument to evaluate patient safety for patients with acute myocardial infarction treated in a predefined care track: a retrospective patient record review study in a single tertiary hospital in the Netherlands.

April 5, 2017

Association of low-dose whole-body computed tomography with missed injury diagnoses and radiation exposure in patients with blunt multiple trauma.

February 5, 2020

Oncology nurses' perceptions about involving patients in the prevention of chemotherapy administration errors.

April 14, 2010

Tenfold therapeutic dosing errors in young children reported to US poison control centers.

July 22, 2009

'Sorry, I meant the patient's left side': impact of distraction on left-right discrimination.

May 13, 2015

Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature.

May 30, 2012

More than an apple a day: factors associated with avoidance of doctor visits among transgender, gender nonconforming, and nonbinary people in the USA.

September 23, 2020

A decade after Francis: is the NHS safer and more open?

April 5, 2023

Uncovering, creating or constructing problems? Enacting a new role to support staff who raise concerns about quality and safety in the English National Health Service

February 19, 2020

Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff?

September 29, 2021

Outcomes with overlapping surgery at a large academic medical center.

February 21, 2018

Intervention study for the reduction of medication errors in elderly trauma patients.

September 2, 2020

Optimization of drug–drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard.

December 10, 2014

Surgery is in itself a risk factor for the patient.

June 1, 2022

Fostering patient safety competencies using multiple-patient simulation experiences.

December 9, 2009

The relationship between patient safety culture and the implementation of organizational patient safety defences at emergency departments.

May 19, 2010

Sleep deprivation and starvation in hospitalised patients: how medical care can harm patients.

October 21, 2015

Defining and classifying terminology for medication harm: a call for consensus.

December 19, 2018

Patients count on it: an initiative to reduce incorrect counts and prevent retained surgical items.

January 18, 2012

Involvement of patients with cancer in patient safety: a qualitative study of current practices, potentials and barriers.

June 26, 2013

Managing alarm systems for quality and safety in the hospital setting.

November 14, 2018

Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015.

March 29, 2017

Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process.

September 20, 2023

Undertaking risk and relational work to manage vulnerability: acute medical patients' involvement in patient safety in the NHS.

March 15, 2023

Errors in cancer diagnosis: current understanding and future directions.

December 19, 2007

Related Resources

Annual Perspective

Equity in Patient Safety

March 27, 2024

Perspective

Patient Safety in Office-Based Care Settings

January 31, 2024

Interview

In Conversation with...Richard Ricciardi about Office-Based Patient Safety

January 31, 2024

Blackbox error management: how do practices deal with critical incidents in everyday practice? A qualitative interview study.

December 13, 2023

Pediatric Diagnostic Safety: State of the Science and Future Directions.

September 13, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Impact of altering referral threshold from out-of-hours primary care to hospital on patient safety and further health service use: a cohort study.

January 11, 2023

How timely is diagnosis of lung cancer? Cohort study of individuals with lung cancer presenting in ambulatory care in the United States.

January 11, 2023

Perspective

Primary Care and Patient Safety: Opportunities at the Interface

September 28, 2022

Interview

In Conversation With... Jack Westfall, MD, MPH

September 28, 2022

Interview

In Conversation With... Freya Spielberg, MD, MPH

September 28, 2022

Quality measures for patients at risk of adverse outcomes in the Veterans Health Administration: expert panel recommendations.

August 17, 2022

Annual Perspective

Patient Safety in the Ambulatory Care Setting

August 5, 2022

When no news is bad news: improving diagnostic testing communication through patient engagement.

March 9, 2022

Improving medical residents’ self-assessment of their diagnostic accuracy: does feedback help?

February 2, 2022

Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis.

January 12, 2022

Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care.

October 27, 2021

Factors associated with potentially missed acute deterioration in primary care: cohort study of UK general practices.

October 20, 2021

Use of heuristics during the clinical decision process from family care physicians in real conditions.

October 6, 2021

WebM&M Cases

Dangers of Missing an Epidural Abscess: Multiple Visits and Delayed Diagnosis with a Severely Negative Outcome

September 29, 2021

Strengths and weaknesses in the diagnostic process of endometriosis from the patients' perspective: a focus group study.

September 15, 2021

Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care.

July 21, 2021

Implementation of patient safety structures and processes in the patient-centered medical home.

June 30, 2021

Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices.

June 30, 2021

Can decision support combat incompleteness and bias in routine primary care data?

April 7, 2021

Suicide as an incident of severe patient harm: a retrospective cohort study of investigations after suicide in Swedish healthcare in a 13-year perspective.

March 31, 2021

Identifying factors leading to harm in English general practices: a mixed-methods study based on patient experiences integrating structural equation modeling and qualitative content analysis.

January 13, 2021

Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review.

December 16, 2020

The diagnostic moment: a study in US primary care.

December 9, 2020

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial.

December 2, 2020

See More About The Topic

Ambulatory Clinic or Office

Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site