Physician arrogance Articles

[waterski232002]

Anyone know of any good journal articles which research physician arrogance and its relationship to poor patient outcome (increased morbidity/mortality, delay to diagnosis, or increased malpractice)

I have had a few instances where people both in the ER or from off services have been very cavalier about "the diagnosis is DEFINITELY X" and they immediately narrow their work-up or stop their work-up prematurely in my opinion.

Four times in the last month I have intervened (or desperately tried to) and caught 2 missed PE's, 1 missed new onset CHF, and 1 misdiagnosed sepsis (thought to be ICH and attending wanted to withdraw care w/o intubating, CT'ing or checking labs). The 2 PE's were going to be sent home, and I curb sided the plan and ordered CT's... the new onset CHF got sent home after I left, despite my input... 1 wk later she returned to the ER and the patients sister came running up to me stating "she's back SOB again!" and sure enough it was CHF.

I got the crazy look from everyone, including the darn paramedic for wanting to intubate, line, lab, and CT the "ICH" guy's head who had AMS and hypotension. They were all like "this isn't sepsis..." and shaking their heads when I disagreed with the consensus to not intubate and withdrawl care. 10 min later after intubating... his CT Head was negative, but he had a WBC of 32, 38% bands, and lactate of 5.2.

How can I convince these people that you don't know what diagnoses you are missing unless you actually work them up appropriately instead of being cavalier.

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[Hard24Get]

You will probably like this:
Do physicians know when their diagnoses are correct? Implications for decision support and error reduction. PMID: 15857490 [PubMed - indexed for MEDLINE]

Are clinicians correct when they believe they are correct? Implications for medical decision support. PMID: 11604781

Both of these studies show that physician confidence/arrogance is often off.

This one shows that though people ca be certain, they may not agree with one another:
Overconfidence among physicians and nurses: the 'micro-certainty, macro-uncertainty' phenomenon.

Soc Sci Med. 1991;32(2):167-74.
PMID: 2014413 [PubMed - indexed for MEDLINE]


The below may also be of interest:

Unscheduled returns to the emergency department: an outcome of medical errors?
Qual Saf Health Care. 2006 Apr;15(2):102-8.
PMID: 16585109 [PubMed - indexed for MEDLINE]

To test or not to test: a clinical dilemma.
Theor Med. 1995 Jun;16(2):141-52.
PMID: 7570394 [PubMed - indexed for MEDLINE]

Anyone know of any good journal articles which research physician arrogance and its relationship to poor patient outcome (increased morbidity/mortality, delay to diagnosis, or increased malpractice)

I have had a few instances where people both in the ER or from off services have been very cavalier about "the diagnosis is DEFINITELY X" and they immediately narrow their work-up or stop their work-up prematurely in my opinion.

Four times in the last month I have intervened (or desperately tried to) and caught 2 missed PE's, 1 missed new onset CHF, and 1 misdiagnosed sepsis (thought to be ICH and attending wanted to withdraw care w/o intubating, CT'ing or checking labs). The 2 PE's were going to be sent home, and I curb sided the plan and ordered CT's... the new onset CHF got sent home after I left, despite my input... 1 wk later she returned to the ER and the patients sister came running up to me stating "she's back SOB again!" and sure enough it was CHF.

I got the crazy look from everyone, including the darn paramedic for wanting to intubate, line, lab, and CT the "ICH" guy's head who had AMS and hypotension. They were all like "this isn't sepsis..." and shaking their heads when I disagreed with the consensus to not intubate and withdrawl care. 10 min later after intubating... his CT Head was negative, but he had a WBC of 32, 38% bands, and lactate of 5.2.

How can I convince these people that you don't know what diagnoses you are missing unless you actually work them up appropriately instead of being cavalier.

 

[waterski232002]

Thanks... those articles are great.

If anyone else has any more good one's to share, let me know....