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Title

[Student’s Name]

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Table of Contents

1. Introduction..............................................................................................................................2

2. Theoretical background............................................................................................................3

2.1 How much is the wrong diagnosis?.......................................................................................4

2.2 How frequently do diagnosis mistakes lead to negative occurrences? What share of

recorded adverse events may be ascribed to diagnostic errors?...................................................4

2.3 Has the diagnostic error rate been declining over time?........................................................5

3. Methodology............................................................................................................................6

4. Analysis....................................................................................................................................6

4.1 Physician overconfidence......................................................................................................6

4.2 Cognitive Aspects of Overconfidence...................................................................................7

4.3 Causes of Cognitive Error......................................................................................................8

5. Conclusion and recommendations..........................................................................................10

5.1 Recommendations................................................................................................................11

References......................................................................................................................................12
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1. Introduction

“Not only are they wrong but physicians are “walking ... in a fog of misplaced optimism”

concerning their confidence”. —Fran Lowry

The effect of a diagnostic error on a particular patient is sensitively highlighted by (Smets,

2019). Large surveys by patients have demonstrated that medical errors in general, and

diagnostic errors in particular, are frequent and of concern to patients and their doctors. (Kovacs,

Lagarde, & Cairns, 2020)For example contacted patients and medical practitioners to see to what

degree they or a family member have suffered medical errors, described as errors that are 'severe

harms, such death, disability or more or longer therapy.' They discovered that 35% of doctors

and 42% of patients reported similar mistakes. Similar results have been discovered in a more

recent US study.201 people commissioned by a firm that promotes a diagnostic decision-making

tool. In the previous 5 years, 35% of these errors have occurred affecting themselves, their

families, or friends; half of these have been diagnostic errors. 35 percent of these caused

continuous damage or death.

Interestingly, 55% of those interviewed named misdiagnosis as the major problem when a doctor

is seen at an outpatient level, while 23% rated it as the most serious error in the hospital

environment. (Schoenherr, Waechter, & Millington, 2018) 38 percent of individuals in the

emergency department also voiced issues about medical errors and misidentified the most

common worry. These studies show that individuals report frequent diagnostic errors and/or have

significant encounters with the health care system. As noted in Tierney's editorial, however,

patients may not always accurately interpret adverse occurrences or argue the causes of the

adverse event with their physicians (Hillen, Raemaekers, Steenbergen, Wetzels, & Verhave,

2018). For this reason, the researcher has studied the scientific literature on diagnostic error
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incidence and effect and examined the overconfidence literature as the main source of diagnostic

error. This latter section examines the documentation on the effectiveness of possible diagnostic

error reduction techniques and advises on future research options.

2. Theoretical background

With many questions in mind, the researcher examined the scientific literature: How much is the

wrong diagnosis? How frequently do diagnosis mistakes lead to negative occurrences? What

share of recorded adverse events may be ascribed to diagnostic errors? Has the diagnostic error

rate been declining over time?

2.1 How much is the wrong diagnosis?

The diagnostic error occurs in each profession, usually the lowest of which depends largely on

visual interpretation for the perceptual disciplines, radiology, and pathology. The pillars of

diagnosis for radiologists and pathologists include a comprehensive knowledge base and know-

how in visual pattern identification. Clinical radionuclide and anatomic pathology error rates

likely range from 2% to 5%, however in some cases far greater levels have been noted. In

practices and institutions that enable x-rays to be read by lead physicians not trained in

radiology, normally low mistake rates in such specialties should not be expected (Smets, 2019).

For instance, up to 16 percent of plain films and 35 percent of cranial-computed-tomography

(CT) tests were incorrectly evaluated in an emergency department doctor's x-ray research

because a staff radiologist was not present. Error rates in clinical specializations are greater in

line with the extra needs of data collection and synthesis than in perceptual specialties. A British

hospital admission study showed that 6% of entrance diagnoses were wrong.   In situations with

over-average uncertainty and stress, the emergency department demands sophisticated decision-

making. The diagnostic error rate in this domain is between 0.6% and 12%. Building on his
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lengthy expertise in diagnostic decision-making, (Bushuven, et al., 2019) calculated a diagnostic

mistake rate of around 15 percent in clinical medicine. In this part, we look at information from a

range of sources that show that this estimate is probably correct.

2.2 How frequently do diagnosis mistakes lead to negative occurrences? What share of

recorded adverse events may be ascribed to diagnostic errors?

There were significant percentage diagnosis mistakes from big retrospective graphic

investigations of adverse occurrences. Diagnostic errors accounted for 17 percent of adverse

outcomes in the Harvard Medical Practice Study of 30,195 hospital records. Follow-up research

from Colorado and Utah with 15,000 records showed that 6.9 percent of adverse events

accounted for diagnostic mistakes. With the same approach, 10.5% of adverse events were

attributed to the diagnostic process in the Canadian Adverse Events Study. The quality of the

Australian healthcare survey revealed 2,351 hospital-related adverse occurrences, with

diagnostic/care delays of 20 percent and information "synthesis/decision/activity" of 15.8

percent. In major research in New Zealand in 1998, 6,579 medical records were analyzed and 8%

of admission diagnostic bugs, of which 11.4% were considered avoidable, were discovered

(Lima de Miranda, Detlefsen, & Stolpe, 2020). 

2.3 Has the diagnostic error rate been declining over time?

Autopsy data allow us to assess if the diagnostic error rate has decreased over time, reflecting

numerous progress in physical imaging and diagnostic analysis. This question has been

addressed in just three significant research. Goldman and colleagues79 have studied in a single

facility in Boston 100 randomly selected autopsy from the years 1960, 1970, and 1980 and

observed a consistent error diagnosis with time. The autopsies studied in Germany in the last

four decades, from 1959 to 1989, were based on a similar technique. Although throughout these
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years the autopsy rate has fallen from 88% to 36%, the misdiagnosis rate has remained steady

(Comin, Skinner, & Staiger, 2018).

Propose that the almost constant error diagnosis rates found during autopsy over the years may

reflect factors that compensate: diagnostic accuracy has improved over time (more knowledge,

better tests, and more competencies). However, since the autopsy declines, only the most

difficult clinical cases of an autopsy have likely been selected that are then more likely to be

diagnosed. A longitudinal autopsy research (consistent 90% autopsy) in Switzerland confirms

that the absolute rate of diagnosis mistakes decreases over time, as anticipated (Ramadhani,

2020). 

3. Methodology

Interpretation is the research philosophy used for this study. According to interpretive research

theory, social reality can be subjectively viewed. The aim is to have a better understanding of the

social circumstances involved. The theory of interpretive research is founded on the assumption

that the researcher perceives the social environment in a certain way. Research philosophy shows

that the research is based on the interests of the investigator and depends on them.

Secondary research is the preferred research approach for this study. Secondary research is a sort

of study that employs previously obtained information. To increase the overall efficacy of the

study, existing information is summarized and collected. Secondary research is recognized as

published research information in research and other comparable sources (SMD, 2021). The

public libraries, internet, and data from previously completed surveys can make this content

available among other sources. Some government and non-governmental organizations also keep

information for the study that may be retrieved and used. The major source of collecting
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secondary data was the internet. One of the most popular means of collecting secondary data is

the Internet. Data may be simply accessed over the internet and downloaded with one click.

4. Analysis

4.1 Physician overconfidence

“.what discourages autopsies is medicine’s twenty-first century, tall-in-the-saddle confidence.”—

attributed to Don Herold

Autopsies not only chronicle the presence of diagnosing mistakes, as noted but give a chance to

learn from one's (Ferrando discimus) errors if you use the information. In the United States,

autopsy rates are no longer monitored but are typically believed to be 10%. In the absence of a

viable choice, this significant feedback mechanism is a distortion for doctors of their mistake

rates. In addition to the absence of autopsies, as Gawande's remark suggests, overconfidence by

physicians might hinder them from using these crucial lessons. In this part, analyze studies of

doctor overconfidence and look at the potential of diagnostic mistake as a key cause. 86

Overconfidence may have both attitudinal and cognitive components and should be

differentiated from self-confidence (Vermaut, 2018).

Fig.2 Top medical error named when the patient has expired
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In coronary artery disease, “HIV-related comorbidities, TB and a large number of malignancies,

delayed or incorrect diagnostic rates of 10-50 percent had been reported. Gandhi and his

colleagues have reported very similar findings, studying 181 cases of ambulatory diagnostic

mistake” (fig. 1) (Gandhi, et al., 2006).

4.2 Cognitive Aspects of Overconfidence

The cognitive aspect is specific to the specific situation (that is, "not knowing what you don't

know"). In one instance the clinician thinks he/she has the proper diagnosis, but he/she is wrong.

Rarely, lack of knowledge alone, like seeing a patient with a disease that the doctor has never

experienced before, maybe the reason for failure to know. More often cognitive errors reflect

problems with data collection such as the lack of full, accurate information from the patient or

failure to recognize the importance of data, such as misinterpretation of the test results. Use of

defective heuristics or using 'coniferous responses.' This usually involves a clinical rationale

breach, as described by (Sajid, 2019). The cognitive component also involves a lack of

metacognition (a willingness and ability to think about one's thinking and analyze one's

assumptions, beliefs, and conclusions critically. found that residents often had a wrong diagnosis,

even if a DSD system suggested that they had a correct diagnosis. Experienced dermatologists

were equally sure that fifty percent of the test cases were diagnosed with melanoma but thirty

percent were incorrect. Doctors also have overconfidence in therapy decisions in test

environments. These studies were conducted in a formal research environment on simulated

clinical cases and, while suggestive, the results are not clear to be the same with actual cases

seen in practice (Edelson, et al., 2019).

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Fig.2 Anticipated effects of overconfidence.

Decision affect theory suggests that overconfidence will make good results appear less surprising

and hence less enjoyable and make poor outcomes seem more shocking and consequently more

painful. Both sorts of consequences will feel worse (fig. 2).

There have been at least twice demonstrations of concrete and clear proof of overconfidence in

medical practice using autopsy findings as the standard of gold. Patients who died and were

autopsy in the ICU were studied by (Ju, Bibaut, & van der Laan, 2018). Medical professionals

were asked to make a clinical diagnosis and also to provide a level of uncertainty: level one was

complete safety, level two was a minor uncertainty, and level three a major uncertainty. In all

three of these groups, there are substantially identical rates of autopsy in which significant

discrepancies were shown between clinical and postmortem diagnosis. In particular, forty

percent of the time, clinicians "completely certain" of the ante mortem diagnosis were wrong.

4.3 Causes of Cognitive Error

It tried to determine the reason for misdiagnosis, retrospective studies on diagnostics' accuracy in

real practice, and the autopsy and other studies described above. During the "synthesis" step,

most of the cognitive errors occur as the physician integrates the medical knowledge with the
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history and findings of the patient. It is largely unconscious and automatic (Schettini, Palozzi, &

Chirico, 2020).

Heuristics: The investigation of such automatic responses showed a wide range of heuristics that

clinicians use to solve diagnostic puzzles (thumb subconscious rules). These answers Croskerry

calls our "cognitive responsiveness predisposition." These heuristics are powerful clinical tools

that allow for a rapid and typically correct resolution of problems. Regrettably, heuristics can

also prevent diagnostic errors by unconscious use. For example, if the problem is solved with the

heuristic availability, a complete diagnosis is unlikely for the clinician because the diagnosis is

so immediately. Similarly, heuristic predisposes to base-rate errors using representativeness. In

other words, the clinician may not be aware that other illnesses may be far more common and

sometimes present similarly when the patient's clinical presentation is matched with the

prototypical case. The following describes additional cognitive errors. These are the most

common causes for cognitive failure in internal medicine, premature closures, and context errors

(Papis & Clavien, 2021).

Premature Closure: Premature closure is too early to restrict the choice of diagnostic

hypotheses to prevent serious consideration of the right diagnosis. This is the medical equivalent

of the concept of "satisfaction" by Herbert Simon. When we find an adequate solution to any

problem we face, we tend to refrain from considering other solutions which may be better. Bias

and Bias-Related Confirmation. These prejudices reflect the trend to look for data to confirm the

idea instead of searching for de confirmation data (Belizan, Irazola, & Belizan, 2020).

Context Errors: Very early in the solution of clinical problems, health care professionals begin

to distinguish between the organ system and the type of anomaly that could be responsible for it.

Many doctors quickly go to the diagnosis of congestive heart failure without taking account of
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other causes of shortness of breath in the event of new breath shortness and old history of heart

problems. Similarly, patients with abdominal pain may be diagnosed with a gastrointestinal

problem, although some chest organs may occur in this way. In these situations, clinicians are

partial to the history, diagnosis, or other factors, and the case is mistakenly defined (Spitzer &

Shaikh, 2020).

Clinical Cognition: There have been relevant research on how doctors first make diagnoses. In

early workings, doctors gather initial data and develop diagnostic hypotheses with what is seen

as a difficult diagnostic problem very fast in seconds. People will then collect more information

to assess these hypotheses and finally come to a diagnostic conclusion. This approach is called

the hypothetical deductive method of diagnostic rationalization and is similar to the traditional

scientific method descriptions. The problems of confirmation partiality and premature closure are

likely to occur during this assessment process (Kumar, Sarawagi, & Jain, 2018).

5. Conclusion and recommendations

There is a significant diagnostic error, from five percent in specialties to fifteen percent in most

other areas of medicine. Diagnostic error is considerable. In this review, we have looked at the

potential for diagnostic error by overconfidence. The literature review leads to two key findings.

There is overconfidence which is probably a feature of human nature we are all inclined to

overestimate the abilities and aptitudes. The overconfidence of doctors in their decision-making

could simply reflect this trend. The doctors are confident in the quick and frugal decisions

typically employed. These strategies are so successful, doctors can become self-sufficient; failure

is low and mistakes cannot be detected for a variety of reasons. The doctors recognize that there

is a diagnostic error, but they appear to think that it is less likely than it is to be. It is unlikely that

you will make a mistake personally. The routines disregard of physical practitioners for
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instruments that can be useful is indirect evidence of overconfidence. Feedback, such as

autopsies, is often sought to clarify their tendency to err, and they tend not to engage in other

exercises that give independent diagnostic information. They ignore diagnostic and therapeutic

guidelines. Even if these are easily accessible and known to be of value when used, they tend to

ignore decision-making tools. Overconfidence Diagnostic error contributions In general, doctors

have well-developed metacognitive abilities and when they are unsure of a case, they typically

spend extra time and attention on the problem. In cases where they are certain, we believe many

or most cognitive errors in the diagnostic arise. These are cases in which the problem seems

routine and is similar to those experienced by the clinician in the past. . In such situations, there

can be no metacognitive angst in more difficult cases. Doctors can just stop thinking about the

case and predispose them to any fitness resulting from our cognitive "response willingness."

People don't look at other contexts or other diagnostic opportunities and don't recognize the

many inherent weaknesses resulting from heuristic thinking. In a nutshell, improving patient

safety will ultimately involve strategies that take the data from this review into account how

diagnostic mistakes occur, how they can be prevented and how to reduce harm.

5.1 Recommendations
Strategies to develop the accuracy of diagnostic decision making

The results of a Friedman and colleagues study showed the same results: training residents did

less than doctors but trusted more in their diagnosis. There were very few links between self-

assessment and objective data when the studies evaluated the precisions of self-assessment of

knowledge in comparison with external competence measurement. The authors also found that

the less expert physicians tended to overconfidently evaluate themselves. These findings suggest

a possible overconfidence solution: doctors become more knowledgeable. The expert is better
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calibrated and excelled to different cases that are easily diagnosed from cases that demand

further reflection (i.e. better assesses his/her accuracy). Experts are more likely to make the

correct diagnosis is recognized as well as unaware cases in addition to their enhanced ability to

make this distinction. In addition, specialists automatically perform these tasks more efficiently

and using fewer resources than non-experts. The addition of more extensive practice and

experience with real clinic cases is another method for gauging knowledge. This approach was

promoted both by (Salla, Blackbright, Johansson, & Salla, 2018) which argued that "practice is

the best performance predictor." The fact that we have a wide repertoire of mentally stored

specimens is also the key to the "free and quick" decision-making. Extensive simulated case

practice may complement, but not supplant, real experiences. The key clinical practice

requirements are comprehensive, i.e. more than a few cases and occasionally feedback is

necessary.
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References

Belizan, M. A., Irazola, V., & Belizan, e. (2020). Barriers to hypertension and diabetes

management in primary health care in Argentina: qualitative research based on a

behavioral economics approach.

Bushuven, S., Weidenbusch, M. M., Fischer, M. R., Juenger, J., Dettenkofer, M., & Bushuven, e.

(2019). Cognitive bias in professional hand hygiene and feedback: A national online-

survey on overconfidence in Germany. Infection Control & Hospital Epidem.

Comin, D., Skinner, J., & Staiger, D. (2018). Overconfidence and the Diffusion of Medical

Technology.

Edelson, S. A., Lo, K. D., Nelson, T., Stark, G., Stratton, M. T., & van Esch, C. (2019). From the

shadow of overconfidence into the light of humility: Reflections on experiential learning

activities gone awry. Journal of Management Education, 43(2), 200.

Gandhi, T. K., Kachalia, A., Thomas, E. J., Puopolo, A. L., Yoon, C., Brennan, T. A., . . .

Gandhi, e. (2006). Missed and delayed diagnoses in the ambulatory setting: a study of

closed malpractice claims. Annals of internal medicine, 145(7), 488-496.

Hillen, J. M., Raemaekers, J. M., Steenbergen, E. J., Wetzels, J. F., & Verhave, J. C. (2018).

Progressive kidney failure in chronic myelomonocytic leukaemia: don’t forget lysozyme

damage. Itching dermatitis on the leg; what is your diagnosis?, 407.

 15

Ju, C., Bibaut, A., & van der Laan, M. (2018). The relative performance of ensemble methods

with deep convolutional neural networks for image classification. Journal of Applied

Statistics, 45(15), 2800-2818.

Kovacs, R. J., Lagarde, M., & Cairns, J. (2020). Overconfident health workers provide lower

quality healthcare. Journal of Economic Psychology, 76, 102213.

Kumar, A., Sarawagi, S., & Jain, U. (2018). Trainable calibration measures for neural networks

from kernel mean embeddings. In International Conference on Machine Learning (pp.

2805-2814). PMLR.

Lima de Miranda, K., Detlefsen, L., & Stolpe, M. (2020). Overconfidence and hygiene non-

compliance in hospitals (No. 2156). Kiel Working Paper.

Papis, T., & Clavien, C. (2021). Do Primary Care Physicians Contribute to the Immunization

Status of Their Adult Patients? A Story of Patients' Overconfidence Coupled With

Physicians' Passivity. Frontiers in Medicine, 8, 907.

Ramadhani, E. (2020). Perception of survival and overconfidence: The case of Najib Razak

(2009–2018). Asian Journal of Comparative Politics, 2057891120959830.

Sajid, I. (2019). Are clinical leads clinical leaders? Optimising primary care-led commissioning

and policy making. British Journal of Healthcare Management, 25(8), 1-8.

Salla, E. P., Blackbright, H., Johansson, P. E., & Salla, e. (2018). June). AI innovations and their

impact on healthcare and medical expertise. In ISPIM Innovation Symposium (pp. 1-15).

The International Society for Professional Innovat.

 16

Schettini, I., Palozzi, G., & Chirico, A. (2020). Enhancing healthcare decision-making process:

Findings from orthopaedic field. Administrative Sciences, 10(4), 94.

Schoenherr, J. R., Waechter, J., & Millington, S. J. (2018). Subjective awareness of ultrasound

expertise development: individual experience as a determinant of overconfidence.

Advances in Health Sciences Education, 23(4), 749-765.

Smets. (2019). Assessment of physicians’ cognitive biases. Internal medicine, 10, 74.

Spitzer, S., & Shaikh, M. (2020). Health misperception and healthcare utilisation among older

europeans.

Vermaut, D. (2018). CEO overconfidence and the influence on firm innovation: s study about

well-established multinationals during 2008-2016 (Doctoral dissertation).