Physical therapists practicing in a direct access setting of performing diagnostic work may find these new tools helpful to maintain a low rate of missed diagnoses.
Isabel Healthcare of Ann Arbor, Michigan and the British Medical Journal (BMJ) of London, England came together to create a new diagnostic decision support tool to help doctors diagnose rare diseases that may be overlooked in the busy clinical environment.
The doctor enters key patient findings into the computer or handheld device and the computer returns a list of potential diagnoses with high-risk "Don't Miss" diagnoses flagged.
A 2009 report titled Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors revealed the top misdiagnoses in medicine. Of 669 cases, the following misdiagnoses were reported:
| Disease | Number of cases | Incidence |
|---|---|---|
| Pulmonary embolism | 26 cases | 4.5% of total |
| Drug reactions or overdose | 26 cases | 4.5% |
| Lung cancer | 23 cases | 3.9% |
| Colorectal cancer | 19 cases | 3.3% |
| Acute coronary syndrome | 18 cases | 3.1% |
| Breast cancer | 18 cases | 3.1% |
| Stroke | 15 cases | 2.6% |
Isabel is a 10-year old clinical decision support tool that has been validated in the peer reviewed literature and is endorsed by the American Medical Association (AMA).
BMJ Best Practice is a point-of-care decision support tool that provides the latest evidence-based medical information from the BMJ Evidence Centre.
Prevention of diagnostic errors can lead to improved accuracy and time of diagnosis and better treatments for patients.
| Timing of Diagnostic Errors | |
|---|---|
| Testing phase: failure to order, report, and follow-up laboratory results | 44% |
| Clinician assessment errors: failure to consider and overweighing competing diagnosis | 32% |
| History taking | 10% |
| Physical examination | 10% |
| Referral or consultation errors and delays | 3% |
This new tool may be of interest to physical therapists who practice in a direct access or primary care setting.
Increasingly, physical therapists are being asked to perform diagnostic decision making in direct access or primary care settings.
The use of new tools and new technologies should help physical therapists maintain a low rate of misdiagnoses.
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