Skip to main content

All Content

Search Tips
Save
Selection
Format
Download
Published Date
Original Publication Date
Original Publication Date
PSNet Publication Date
Additional Filters
1 - 20 of 510

A 44-year-old man presented to his primary care physician (PCP) with complaints of new onset headache, photophobia, and upper respiratory tract infections. He had a recent history of interferon treatment for Hepatitis C infection and a remote history of cervical spine surgery requiring permanent spinal hardware. On physical examination, his neck was tender, but he had no neurologic abnormalities. He was sent home from the clinic with advice to take over-the-counter analgesics.

A 31-year-old woman presented to the ED with worsening shortness of breath and was unexpectedly found to have a moderate-sized left pneumothorax, which was treated via a thoracostomy tube. After additional work-up and computed tomography (CT) imaging, she was told that she had some blebs and mild emphysema, but was discharged without any specific follow-up instructions except to see her primary care physician.

Fatemi Y, Coffin SE. Diagnosis (Berl). 2021;8:525-531.
Using case studies, this commentary describes how availability bias, diagnostic momentum, and premature closure resulted in delayed diagnosis for three pediatric patients first diagnosed with COVID-19. The authors highlight cognitive and systems factors that influenced this diagnostic error.

Beginning in her teenage years, a woman began "feeling woozy" after high school gym class. The symptoms were abrupt in onset, lasted between 5 to 15 minutes and then subsided after sitting down. Similar episodes occurred occasionally over the following decade, usually related to stress. When she was in her 30s, she experienced a more severe episode of palpitations and went to the emergency department (ED). An electrocardiogram (ECG) was normal and she was discharged with a diagnosis of stress or possible panic attack.

Sinha P, Pischel L, Sofair AN. Diagnosis (Berl). 2021;8:157-160.
Reducing diagnostic error is essential to patient safety. This article describes the use of structured education sessions and deliberate practice with senior clinicians to improve diagnostic skills among medical residents. These sessions focused on generating differential diagnoses and identifying cognitive errors and knowledge gaps.
Erkelens DC, Rutten FH, Wouters LT, et al. J Patient Saf. 2022;18:40-45.
Delays in diagnosis and treatment during after-hours care pose serious threats to patient safety. This case-control study compared missed acute coronary syndrome (ACS) cases to other cases with chest discomfort occurring during out-of-hours services in primary care. Predictors of missed ACS included the use of cardiovascular medication, non-retrosternal chest pain, and consultation of the supervising general practitioner.   

Boodman SG. Washington Post. January 23, 2021.

Misdiagnosis can perpetuate over a long period and delay a correct course of treatment. This news feature shares an example of depression misdiagnosis that masked the true problem of a neurological tumor manifesting in what was seen and treated as a psychological condition. 
Bhat A, Mahajan V, Wolfe N. J Clin Neurosci. 2021;85:27-35.
Misdiagnosis, variation in treatment of stroke and gaps in secondary prevention in young patients can result in adverse outcomes. This article discusses the possible causes of implicit bias in stroke care in this population, the effects of bias on patient outcomes, and interventions to circumvent implicit bias.  

Croskerry P. New York, NY: Oxford University Press; 2020. ISBN: 9780190088743. 

Diagnostic error reduction methods are evolving to enhance efforts supporting diagnostic improvements. This publication uses clinical cases to examine cognitive elements that contribute to problematic decision making. The model illustrates how bias and other reasoning flaws are more likely to result in diagnostic errors than a lack of knowledge would. 

After a breast mass was identified by a physician assistant during a routine visit, a 60-year-old woman received a diagnostic mammogram and ultrasound. The radiology assessment was challenging due to dense breast tissue and ultimately interpreted as “probably benign” findings. When the patient returned for follow-up 5 months later, the mass had increased in size and she was referred for a biopsy.

A 60-year-old male presented to the emergency department (ED) with his partner after an episode of dizziness and syncope when exercising. An electrocardiogram demonstrated non-ST-elevation myocardial infarction abnormalities. A brain CT scan was ordered but the images were not assessed prior to initiation of anticoagulation treatment. While awaiting further testing, the patient’s heart rate slowed and a full-body CT scan demonstrated an intracranial hemorrhage. An emergent craniotomy was performed and the patient later died.

Skin of Color Society Foundation, NEJM Group, and VisualDx. October 28--December 2, 2020.

Diagnostic decision making can be affected by implicit racial bias. This 4-part series explored tools and techniques to improve diagnosis in patients of color. Topics covered included structural racism, explicit analysis of disease patterns and treatments, cultural competency, and policy improvement.   
Zolnikov T, Zolnikov TR. J Prim Care Community Health. 2020;11:215013272095986.
This commentary describes the challenges of traditional approaches to differential diagnosis during the COVID-19 pandemic. The authors suggest the use of a “bottom-up” approach to diagnosis, which first eliminates the rare and/or serious diagnoses before moving on to more common diagnoses, thereby ensuring that all patients are screened for more serious diseases and improving timely diagnosis.     
Cantey C. J Nurs Pract. 2020;16:582-585.
This article discusses cognitive decision processes and biases, and their consequences on clinical decision making by nurse practitioners. The authors present several clinical examples of diagnostic error and discuss strategies to avoid future errors.
Boyle JG, Walters MR, Jamieson S, et al. Diagnosis (Berl). 2020;7:177-179.
In this Letter to the Editor, the authors suggest that the COVID-19 pandemic presents a unique opportunity to consider how situational factors impact clinical reasoning performance and lead to errors. The authors discuss the potential implications through a clinical story involving a redeployed resident working in a COVID-19 assessment and treatment unit and an older man with respiratory symptoms. 
Schiff GD, Mirica MM. Diagnosis (Berl). 2020;7:377-380.
This commentary discuses key issues related to diagnostic accuracy in the era of COVID-19, including considering differential diagnoses for COVID-19, the challenges of remote diagnoses, and the consequences of lapses in routine diagnostic and preventive care.