Diagnostic Error: Is Overconfidence the Problem. Edited by Mark L. Graber MD, FACP, Eta S. Berner EdD, FACMI, FHIMSS. The American Journal of Medicine 121(5S) Supplement (May 2008). 

The supplement was sponsored by the Paul Mongerson Foundation through the Raymond James Charitable Endowment Fund.

Many of the ideas expressed here emerged from discussions at a meeting among the authors in Naples, Florida, in December 2006 that was sponsored by the University of Alabama at Birmingham with support from the Paul Mongerson Foundation.

Diagnostic Error: Is Overconfidence the Problem. Edited by Mark L. Graber MD, FACP, Eta S. Berner EdD, FACMI, FHIMSS. The American Journal of Medicine 121(5S) Supplement (May 2008).

Foreword (by Paul Mongerson). After being misdiagnosed with pancreatic cancer in 1980, I founded the Computer Assisted Medical Diagnosis and Treatment Foundation to improve the accuracy of medical diagnosis. The foundation has sponsored programs to develop and evaluate computerized programs for medical diagnosis and to encourage physicians to use computers for their order entry. My role was insignificant, but as the result of much work by many people, substantial progress has been made. Physicians today are clearly more accepting of computer assistance and this movement is accelerating.

However, in 2006, I became worried after questioning my personal physicians as to why they did not use computers for diagnosis more often. Most explained that their diagnostic error rate was <1% and that computer use was time consuming. However, I had read that studies of diagnostic problem solving showed an error rate ranging from 5% to 10%. The physicians attributed the higher error rates to “other” less skilled physicians; few felt a need to improve their own diagnostic abilities.

From my perspective as a patient, even an error rate of 1% is unacceptable. It is ironic that most physicians I have asked are convinced there is much room for improvement in diagnosis—by other physicians. In my view, diagnostic error will be reduced only if physicians have a more realistic understanding of the amount of diagnostic errors they personally make. I believe that the accuracy of diagnosis can be best improved by informing physicians of the extent of their own (not others') errors and urging them to personally take steps to reduce their own mistakes.

It is logical that physicians' overconfidence in their ability inadvertently reduces the attention they give to reducing their own diagnostic errors. Unfortunately, this sensitive problem is rarely discussed and it is understudied. This supplement to The American Journal of Medicine, which features Drs. Eta S. Berner and Mark L. Graber's comprehensive review of a broad range of literature on the extent of diagnostic errors, the causes, and strategies to reduce them, addresses that gap.

Drs. Berner and Graber conducted the literature review and developed a framework for strategies to address the problem. Their colleagues' commentaries expand and refine our understanding of the causes of errors and the strategies to reduce them. The papers in this supplement confirm the extent of diagnostic errors and suggest improvement will best come by developing systems to provide physicians with better feedback on their own errors.

Hopefully this set of articles will inspire us to improve our own diagnostic accuracy and to develop systems that will provide diagnostic feedback to all physicians.