Most of us think we have fair insight into our own medical decision-making. When presented with a difficult case, I think most would presume to present a provisional diagnosis with a decreased level of confidence.
Apparently, nope.
This fascinating insight into decision-making comes from a set of clinical case vignettes distributed to physician volunteers. 118 physicians were recruited via e-mail to complete four structured case presentations – two “easy”, two “difficult”. Physicians were not specifically notified regarding the variable difficulty of the cases involved. They were provided first the history, then the exam, followed by results of general and specific testing, if requested. During each stage of the process, physicians were asked to provide preliminary diagnoses and their level of confidence.
For the two easy cases, the mean confidence level of respondents was a little over 70%. And, final diagnostic accuracy was a little under 50%. For the difficult cases, the mean confidence level of respondents was about 65%. And diagnostic accuracy was … 5%. Almost as confident, almost never right.
Physician characteristics provided few insights regarding behavior, confidence, and accuracy. Increasing years of experience were related to decreased testing and consultation requests – but, for the most part, the only insight: physicians are lacking in insight.
“Physicians’ Diagnostic Accuracy, Confidence, and Resource Requests”
http://www.ncbi.nlm.nih.gov/pubmed/23979070