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Calibrating how doctors think and seek information to minimise errors in diagnosis
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  1. Ashley N D Meyer1,2,
  2. Hardeep Singh1,2
  1. 1Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
  2. 2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Ashley N D Meyer, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA; ameyer{at}bcm.edu

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Information gathering is a foundational step of the diagnostic process.1 It is not possible to synthesise clinical information to make a correct diagnosis without adequate data collection related to a patient's history, physical examination, test results or consultations with other clinicians. However, evidence over the last several decades suggests that failures in information gathering are common and feature prominently in analyses of diagnostic errors.2–7 Many information-gathering failures are related to history taking, including asking the right questions, which is sometimes based on certain cues from the patient.

In this issue of BMJ Quality and Safety, Sheringham et al8 used simulated patient vignettes to understand the role that patient characteristics (including demographics and symptomatology) play in physicians' decisions to investigate for possible diagnosis of lung cancer. They found that despite suggestive initial symptoms, general practitioners (GPs) failed to elicit additional key symptoms from ‘patients’ that would have suggested the need to investigate further through ordering of tests (chest X-rays or CT scans) or referral to a respiratory consultant. GPs were more likely to initiate investigations when they elicited these additional symptoms that the ‘patient’ had, but did not initially volunteer. The omission of symptom elicitation persisted even in patients with higher risk of lung cancer. While the authors found patient characteristics, such as race and age, related to GPs' investigational behaviours, these factors only accounted for a small proportion of failures to investigate.

What then can explain these differences in information gathering by GPs? In real-world practice, one of the usual suspects is insufficient time,9 which we ourselves have implicated before.3 However, in this study, there was no specific time restriction on the GPs, suggesting we must seek additional reasons. In the real world, physicians sometimes have difficulty in extracting relevant historical data from the …

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