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Sensitivity for multimorbidity: The role of diagnostic uncertainty of physicians when evaluating multimorbid video case-based vignettes


Hausmann, Daniel; Kiesel, Vera; Zimmerli, Lukas; Schlatter, Narcisa; von Gunten, Amandine; Wattinger, Nadine; Rosemann, Thomas (2019). Sensitivity for multimorbidity: The role of diagnostic uncertainty of physicians when evaluating multimorbid video case-based vignettes. PLoS ONE, 14(4):e0215049.

Abstract

BACKGROUND: Multimorbidity can be defined as the co-occurrence of two or more chronic medical conditions in one person. Within the diagnostic process, accurately detecting a multimorbid disease pattern still poses a major challenge for most physicians, and is known as a source of diagnostic uncertainty.
OBJECTIVE: We investigated, how sensitive, confident, and accurate physicians are in diagnosing multimorbid versus monomorbid patients.
METHODS: We created eight video case-based vignettes, which differed in type of morbidity (multimorbid versus monomorbid), field of medical specialization (somatic versus mental), and relatedness of underlying diseases (causally related versus unrelated). In total, 74 physicians (GPs, residents in an emergency department and psychiatrists) watched three to five randomly allocated video cases and had to generate suspected diagnoses at the end of each of three video sequences. Additionally, participating physicians rated subjective confidence for all mentioned diagnoses and for three sequences per case with the help of confidence profiles.
RESULTS: Altogether, physicians made a large number of accurate diagnoses (69%). Nevertheless, the overall number of underdiagnosed multimorbid cases (misses) was significantly higher (71%) than over-diagnosed monomorbid cases (false alarms) (7%).
DISCUSSION: According to Signal Detection Theory, GPs and psychiatrists both showed lower detection performance for medical cases that lay beyond their own field of specialization. Remarkably, residents show the highest sensitivity for multimorbid cases with an approximately identically detection performance d' slightly over 1 for both field of medical specialization (somatic and mental). Furthermore, higher uncertainty in diagnosing multimorbid cases is related to lower confidence especially at the beginning of a diagnostic process, as well as to unrelated and therefore probably rare disease pattern. Several limitations of the study and the video case-based vignettes are described within the discussion section.
CONCLUSIONS: Physicians have to be sensitized for multimorbidity even more, and have to be taught in the prevalence of existing disease combinations. Communicating uncertainty with other specialists could be helpful when faced with a sometimes "fuzzy" pattern of symptoms.

Abstract

BACKGROUND: Multimorbidity can be defined as the co-occurrence of two or more chronic medical conditions in one person. Within the diagnostic process, accurately detecting a multimorbid disease pattern still poses a major challenge for most physicians, and is known as a source of diagnostic uncertainty.
OBJECTIVE: We investigated, how sensitive, confident, and accurate physicians are in diagnosing multimorbid versus monomorbid patients.
METHODS: We created eight video case-based vignettes, which differed in type of morbidity (multimorbid versus monomorbid), field of medical specialization (somatic versus mental), and relatedness of underlying diseases (causally related versus unrelated). In total, 74 physicians (GPs, residents in an emergency department and psychiatrists) watched three to five randomly allocated video cases and had to generate suspected diagnoses at the end of each of three video sequences. Additionally, participating physicians rated subjective confidence for all mentioned diagnoses and for three sequences per case with the help of confidence profiles.
RESULTS: Altogether, physicians made a large number of accurate diagnoses (69%). Nevertheless, the overall number of underdiagnosed multimorbid cases (misses) was significantly higher (71%) than over-diagnosed monomorbid cases (false alarms) (7%).
DISCUSSION: According to Signal Detection Theory, GPs and psychiatrists both showed lower detection performance for medical cases that lay beyond their own field of specialization. Remarkably, residents show the highest sensitivity for multimorbid cases with an approximately identically detection performance d' slightly over 1 for both field of medical specialization (somatic and mental). Furthermore, higher uncertainty in diagnosing multimorbid cases is related to lower confidence especially at the beginning of a diagnostic process, as well as to unrelated and therefore probably rare disease pattern. Several limitations of the study and the video case-based vignettes are described within the discussion section.
CONCLUSIONS: Physicians have to be sensitized for multimorbidity even more, and have to be taught in the prevalence of existing disease combinations. Communicating uncertainty with other specialists could be helpful when faced with a sometimes "fuzzy" pattern of symptoms.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
06 Faculty of Arts > Institute of Psychology
Dewey Decimal Classification:150 Psychology
Scopus Subject Areas:Life Sciences > General Biochemistry, Genetics and Molecular Biology
Life Sciences > General Agricultural and Biological Sciences
Health Sciences > Multidisciplinary
Language:English
Date:2019
Deposited On:04 Feb 2020 13:47
Last Modified:01 Jul 2020 21:14
Publisher:Public Library of Science (PLoS)
ISSN:1932-6203
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1371/journal.pone.0215049
PubMed ID:30970008

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