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2.
Neonatal Netw ; 38(2): 113-115, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470376

RESUMO

An expected complex outcome of a premature infant need not be assumed completely life limiting. Take Erik Zimmerman, an adult born early 40+ years ago that did end up with cerebral palsy. Yet he chose the gifts that the diagnosis provides and proves many people wrong in terms of what he can and cannot do. The result is a wonderful interview with an inspiring individual and tips for neonatal nurses that will inform them in the NICU as they carry forward wisdom to new families facing the same challenges.


Assuntos
Paralisia Cerebral , Erros de Diagnóstico/prevenção & controle , Pessoas com Deficiência , Enfermagem Neonatal , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/psicologia , Erros de Diagnóstico/psicologia , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Diagnóstico Precoce , Inteligência Emocional , Humanos , Unidades de Terapia Intensiva Neonatal , Enfermagem Neonatal/métodos , Enfermagem Neonatal/normas , Competência Profissional
3.
Aerosp Med Hum Perform ; 90(7): 652-654, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31227041

RESUMO

BACKGROUND: Physicians rely on intuition and pattern recognition to rapidly evaluate and treat patients. While the realities of our medical system require liberal use of these heuristics to efficiently make clinical decisions, such thinking patterns are error-prone-leaving the clinician at the whims of their cognitive biases.CASE REPORT: We describe a case of Lyme disease in which a pilot's rash and radicular pain were misdiagnosed on two separate occasions until, nearly a month after initially seeking medical care, the pilot was appropriately diagnosed and treated.DISCUSSION: This case highlights Lyme disease's mimicry of other common diseases and underscores the need to use slower, more deliberate evaluation in conjunction with pattern recognition and intuition to provide optimal care to flyers.Saul S, Tanael M. Rash, radiculopathy, and cognitive biases. Aerosp Med Hum Perform. 2019; 90(7):652-654.


Assuntos
Tomada de Decisão Clínica/métodos , Erros de Diagnóstico/psicologia , Heurística , Doença de Lyme/diagnóstico , Cirurgiões/psicologia , Adulto , Medicina Aeroespacial , Celulite (Flegmão)/complicações , Celulite (Flegmão)/diagnóstico , Exantema/etiologia , Humanos , Doença de Lyme/complicações , Masculino , Militares , Pilotos , Síndrome do Músculo Piriforme/complicações , Síndrome do Músculo Piriforme/diagnóstico , Radiculopatia/etiologia
4.
Arthritis Care Res (Hoboken) ; 71(3): 343-351, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30724039

RESUMO

OBJECTIVE: Recent studies have suggested that fibromyalgia is inaccurately diagnosed in the community, and that ~75% of persons reporting a physician diagnosis of fibromyalgia would not satisfy published criteria. To investigate possible diagnostic misclassification, we compared expert physician diagnosis with published criteria. METHODS: In a university rheumatology clinic, 497 patients completed the Multidimensional Health Assessment Questionnaire (MD-HAQ) and the 2010 American College of Rheumatology preliminary diagnostic criteria modified for self-administration during their ordinary medical visits. Patients were evaluated and diagnosed by university rheumatology staff. RESULTS: Of the 497 patients, 121 (24.3%) satisfied the fibromyalgia criteria, while 104 (20.9%) received a clinician International Classification of Diseases (ICD) diagnosis of fibromyalgia. The agreement between clinicians and criteria was 79.2%. However, agreement beyond chance was only fair (κ = 0.41). Physicians failed to identify 60 criteria-positive patients (49.6%) and incorrectly identified 43 criteria-negative patients (11.4%). In a subset of 88 patients with rheumatoid arthritis (RA), the kappa value was 0.32, indicating slight to fair agreement. Universally, higher polysymptomatic distress scores and criteria-based diagnosis were associated with more abnormal MD-HAQ clinical scores. Women and patients with more symptoms but fewer pain areas were more likely to receive a clinician's diagnosis than to satisfy fibromyalgia criteria. CONCLUSION: There is considerable disagreement between ICD clinical diagnosis and criteria-based diagnosis of fibromyalgia, calling into question ICD-based studies. Fibromyalgia criteria were easy to use, but problems regarding clinician bias, meaning of a fibromyalgia diagnosis, and the validity of physician diagnosis were substantial.


Assuntos
Centros Médicos Acadêmicos/normas , Instituições de Assistência Ambulatorial/normas , Erros de Diagnóstico , Fibromialgia/diagnóstico , Papel do Médico , Centros Médicos Acadêmicos/métodos , Adulto , Idoso , Erros de Diagnóstico/psicologia , Feminino , Fibromialgia/epidemiologia , Fibromialgia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/normas , Papel do Médico/psicologia
5.
Curr Probl Diagn Radiol ; 48(3): 207-209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29506879

RESUMO

BACKGROUND: Telephone calls remain one of the most frequent interruptions in radiology reporting rooms, despite modern electronic order communication systems. A call received by a radiology trainee during the hour before completing a report may increase the chance of a discrepancy by 12%. AIM: To characterise telephone calls to radiology reporting rooms and identify ways to reduce these interruptions. METHODS AND MATERIALS: An observational study over five working days (10 programmed activity reporting sessions equivalent) was conducted across 2 large teaching hospital reporting rooms. Radiologists were requested to record all calls between 9a.m and 5p.m on a preprepared Excel proforma and indicate their initial rating of call appropriateness. RESULTS: A total of 288 calls recorded, 92% (266/288) interrupted reporting. Reasons for calls were 48% (139/288) ask for a request to be vetted, 17% (50/288) ask for a study to be reported, 17% (45/288) "other," 7% (19/288) discuss choice of study, 6% (16/288) review a report, 3% (9/288) wrong number, 2% (7/288) returning a bleep, and 1% (3/288) provide further explanation in addition to the electronic request form. CONCLUSION: Radiologists and referrers remain over reliant on telephone interruptions for their workflow. Attempts to educate referrers previously reduced calls to a computed tomography reporting room by 28%. Our recommendations include (1) defining protected activities, (2) adhering to fully electronic requesting and vetting processes, other than in time critical or exceptional circumstances, (3) electronic critical report alerts and review of report priority triaging to reduce calls for reports, (4) revising duty radiologist timetables to tackle nonreporting responsibilities, and (5) improving new doctor induction in the organization to improve radiology request practice.


Assuntos
Atenção , Radiologistas/psicologia , Radiologistas/normas , Telefone , Fluxo de Trabalho , Erros de Diagnóstico/psicologia , Eficiência , Humanos , Segurança do Paciente , Melhoria de Qualidade
6.
Hastings Cent Rep ; 48 Suppl 4: S77-S80, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584845

RESUMO

For nearly five years, bioethicists and neurologists debated whether Jahi McMath, an African American teenager, was alive or dead. While Jahi's condition provides a compelling study for analyzing brain death, circumscribing her life status to a question of brain death fails to acknowledge and respond to a chronic, if uncomfortable, bioethics problem in American health care-namely, racial bias and unequal treatment, both real and perceived. Bioethicists should examine the underlying, arguably broader social implications of what Jahi's medical treatment and experience represented. On any given day, disparities in the quality of health care and health outcomes for people of color in comparison to whites are evidenced in American hospitals and clinics. These disparities are not entirely explained by differences in patient education, insurance status, employment, income, expressed preference for treatments, and severity of disease. Instead, research indicates that, even for African Americans able to gain access to health care services and navigate institutional nuances, disparities persist across a broad range of services, including diagnostic screening and general medical care, mental health diagnosis and treatment, pain management, HIV-related care, and treatments for cancer, heart disease, diabetes, and kidney disease.


Assuntos
Morte Encefálica , Morte , Erros de Diagnóstico , Cuidados para Prolongar a Vida , Administração dos Cuidados ao Paciente , Afro-Americanos , Morte Encefálica/diagnóstico , Morte Encefálica/fisiopatologia , Erros de Diagnóstico/ética , Erros de Diagnóstico/psicologia , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde/etnologia , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/normas , Racismo , Fatores Socioeconômicos
7.
Hastings Cent Rep ; 48 Suppl 4: S74-S76, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584850

RESUMO

From the start, I followed the case of Jahi McMath with great interest. In December 2013, she clearly fulfilled the diagnostic criteria for brain death. As a neurologist with a special interest in chronic brain death, I was not surprised that, after she was flown to New Jersey, where she became statutorily resurrected and was treated as a comatose patient, Jahi's condition quickly improved. In 2014, her family reported that she sometimes responded to simple motor commands. I shared the general skepticism regarding these reports, assuming that the family was in denial and was misinterpreting spinal myoclonus (a rapid, involuntary twitch generated by the spinal cord) as volitional. The family had noticed that when Jahi's heart rate was above eighty beats per minute, she was more likely to respond, as though the heart rate reflected some sort of inner level of arousal. So they began to make video recordings. I have been privileged to be entrusted with copies of these recordings, forty-eight of which proved suitable for assessing alleged responsiveness. All have been certified by a forensic video expert as unaltered. The first thing that struck me was that the great majority of the alleged responses were not spinal myoclonus. In fact, they did not resemble any type of spontaneous, involuntary movement described in patients paralyzed from high spinal cord lesions.


Assuntos
Atitude do Pessoal de Saúde , Morte Encefálica , Morte , Erros de Diagnóstico , Cuidados para Prolongar a Vida , Morte Encefálica/diagnóstico , Morte Encefálica/fisiopatologia , Estado de Consciência/fisiologia , Erros de Diagnóstico/ética , Erros de Diagnóstico/psicologia , Técnicas de Diagnóstico Neurológico , Feminino , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia
8.
Hastings Cent Rep ; 48 Suppl 4: S70-S73, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584856

RESUMO

Jahi McMath's case has raised challenging uncertainties about one of the most profound existential questions that we can ask: how do we know whether someone is alive or dead? The case is striking in at least two ways. First, how can it be that a person diagnosed as dead by qualified physicians continued to live, at least in a biological sense, more than four years after a death certificate was issued? Second, the diagnosis of brain death has been considered irreversible; in fact, there has never been a case of a person correctly diagnosed as brain-dead who improved to the point that the person no longer fulfilled the diagnostic criteria. If the neurologist Alan Shewmon is correct that, prior to her cardiac arrest in June 2018, McMath no longer met the criteria for brain death and was actually in a minimally conscious state, this case could have momentous implications for how we think about this diagnosis going forward. In this essay, I will offer a hypothesis that could, perhaps, explain both these aspects of the case. The hypothesis is based on differences in how we distinguish between biological and legal categories. The law tends to prefer to draw bright-line distinctions between categories, whereas biological categories tend to fall along a spectrum, without sharp distinctions.


Assuntos
Atitude Frente a Morte , Morte Encefálica/diagnóstico , Morte , Erros de Diagnóstico , Cuidados para Prolongar a Vida , Estado de Consciência , Erros de Diagnóstico/ética , Erros de Diagnóstico/psicologia , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia
9.
Br J Dermatol ; 179(6): 1270-1276, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30171684

RESUMO

Diagnostic errors are the most common, costly and dangerous of medical mistakes. In part 1 of this series, we described how general and dermatology-specific cognitive and perceptual biases underlie most of our correct diagnoses, as well as being a source of diagnostic medical errors. In this second part of the series, we describe some tactics to combat diagnostic error. Metacognition, or thinking about how we think, is the central approach advocated to avoid errors of 'uncritical' diagnostic thinking. Current individual and medical cultural attitudes need to be modified in order to incorporate improvements in diagnosis. Algorithms, artificial intelligence and system changes are being developed to address error and improve diagnostic accuracy.


Assuntos
Dermatologistas/psicologia , Erros de Diagnóstico/prevenção & controle , Heurística , Metacognição , Dermatopatias/diagnóstico , Fadiga de Alarmes do Pessoal de Saúde/prevenção & controle , Tomada de Decisão Clínica/métodos , Técnicas de Apoio para a Decisão , Dermatologia/métodos , Dermatologia/organização & administração , Erros de Diagnóstico/psicologia , Humanos , Intuição , Participação do Paciente , Pele/diagnóstico por imagem , Pele/patologia , Dermatopatias/patologia
10.
BMC Psychiatry ; 18(1): 317, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261851

RESUMO

BACKGROUND: Mental health clinicians have previously been reported to express reservations regarding the utility and accuracy of the psychiatric classification systems. In this study we aimed to examine clinicians' experiences with instances of perceived inaccuracy of a schizophrenia diagnosis. METHODS: Mental health clinicians (N = 175) participated in an online survey assessing prevalence and perceived reasons for inaccuracies of a schizophrenia diagnosis. Respondents included psychiatric ward directors (13.1%), senior psychiatrists and psychologists (40.5%), and psychiatry and clinical psychology residents (36%). RESULTS: Fifty-three percent of respondents reported encountering instances where a schizophrenia diagnosis was assigned even though clinical presentation did not match diagnostic criteria. Seventy-three percent of senior psychiatrists in a position to determine a diagnosis declared assigning schizophrenia even when controversial among clinical staff, and 15% of them declared doing so frequently. The likelihood of frequently assigning a schizophrenia diagnosis even when clearly controversial was predicted by the perception that an inaccurate diagnosis is assigned due to the presence of negative symptoms (OR 2.20, 95% CI 1.04-4.66, p = 0.039) and due to patient-related factors, such as the need to facilitate rehabilitation (OR 1.77, 95% CI 1.07-2.90, p = 0.024). CONCLUSIONS: Although a schizophrenia diagnosis is considered relatively stable and clear, our study indicates that, in clinical practice, the assignment of this diagnosis is frequently controversial. These controversies are associated with the perception that an inaccurate diagnosis is assigned due to diagnostic considerations, or due to the possibility that patients might benefit from such a diagnosis. Implications and limitations for psychiatric practice and discourse are discussed.


Assuntos
Atitude do Pessoal de Saúde , Erros de Diagnóstico/psicologia , Psiquiatria/estatística & dados numéricos , Esquizofrenia/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
Diagnosis (Berl) ; 5(4): 179-189, 2018 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30231010

RESUMO

Background Clinical medicine has long recognized the potential for cognitive bias in the development of new treatments, and in response developed a tradition of blinding both clinicians and patients to address this specific concern. Although cognitive biases have been shown to exist which impact the accuracy of clinical diagnosis, blinding the diagnostician to potentially misleading information has received little attention as a possible solution. Recently, within the forensic sciences, the control of contextual information (i.e. information apart from the objective test results) has been studied as a technique to reduce errors. We consider the applicability of this technique to clinical medicine. Content This article briefly describes the empirical research examining cognitive biases arising from context which impact clinical diagnosis. We then review the recent awakening of forensic sciences to the serious effects of misleading information. Comparing the approaches, we discuss whether blinding to contextual information might (and in what circumstances) reduce clinical errors. Summary and outlook Substantial research indicates contextual information plays a significant role in diagnostic error and conclusions across several medical specialties. The forensic sciences may provide a useful model for the control of potentially misleading information in diagnosis. A conceptual analog of the forensic blinding process (the "agnostic" first reading) may be applicable to diagnostic investigations such as imaging, microscopic tissue examinations and waveform recognition. An "agnostic" approach, where the first reading occurs with minimal clinical referral information, but is followed by incorporation of the clinical history and reinterpretation, has the potential to reduce errors.


Assuntos
Tomada de Decisão Clínica/métodos , Cognição , Erros de Diagnóstico/psicologia , Ciências Forenses , Viés , Erros de Diagnóstico/prevenção & controle , Humanos , Anamnese , Qualidade da Assistência à Saúde
13.
Br J Dermatol ; 179(6): 1263-1269, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29962022

RESUMO

Sir William Osler famously, and ironically, stated that 'Medicine is a science of uncertainty and an art of probability'. The processes by which each physician metes out diagnostic uncertainty and navigates probabilities in dermatology is far from uniform. While certain ubiquitous cognitive and visual heuristics can enhance diagnostic speed, they also create pitfalls and thinking traps that introduce significant variation in the diagnostic process. Discussed in this part of a two-part article are various cognitive and visual heuristics as they pertain to skin disease, with an introduction and special attention paid to the heuristic methods classically applied by dermatologists. How to best address error and improve our thought processes will be addressed in part 2.


Assuntos
Cognição , Dermatologistas/psicologia , Erros de Diagnóstico/psicologia , Heurística , Dermatopatias/diagnóstico , Percepção Visual , Dermatologia/métodos , Erros de Diagnóstico/prevenção & controle , Humanos , Pele/diagnóstico por imagem , Pele/patologia , Dermatopatias/patologia
15.
J Eval Clin Pract ; 24(5): 978-982, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29790242

RESUMO

Novel tests give great opportunities for earlier and more precise diagnostics. At the same time, new tests expand disease, produce patients, and cause unnecessary harm in overdiagnosis and overtreatment. How can we evaluate diagnostics to obtain the benefits and avoid harm? One way is to pay close attention to the diagnostic process and its core concepts. Doing so reveals 3 errors that expand disease and increase overdiagnosis. The first error is to decouple diagnostics from harm, eg, by diagnosing insignificant conditions. The second error is to bypass proper validation of the relationship between test indicator and disease, eg, by introducing biomarkers for Alzheimer's disease before the tests are properly validated. The third error is to couple the name of disease to insignificant or indecisive indicators, eg, by lending the cancer name to preconditions, such as ductal carcinoma in situ. We need to avoid these errors to promote beneficial testing, bar harmful diagnostics, and evade unwarranted expansion of disease. Accordingly, we must stop identifying and testing for conditions that are only remotely associated with harm. We need more stringent verification of tests, and we must avoid naming indicators and indicative conditions after diseases. If not, we will end like ancient tragic heroes, succumbing because of our very best abilities.


Assuntos
Erros de Diagnóstico/prevenção & controle , Técnicas e Procedimentos Diagnósticos , Sobremedicalização/prevenção & controle , Erros de Diagnóstico/psicologia , Técnicas e Procedimentos Diagnósticos/ética , Técnicas e Procedimentos Diagnósticos/psicologia , Técnicas e Procedimentos Diagnósticos/tendências , Humanos , Filosofia Médica , Medição de Risco
16.
AJR Am J Roentgenol ; 210(5): 1097-1105, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29528716

RESUMO

OBJECTIVE: The field of cognitive science has provided important insights into mental processes underlying the interpretation of imaging examinations. Despite these insights, diagnostic error remains a major obstacle in the goal to improve quality in radiology. In this article, we describe several types of cognitive bias that lead to diagnostic errors in imaging and discuss approaches to mitigate cognitive biases and diagnostic error. CONCLUSION: Radiologists rely on heuristic principles to reduce complex tasks of assessing probabilities and predicting values into simpler judgmental operations. These mental shortcuts allow rapid problem solving based on assumptions and past experiences. Heuristics used in the interpretation of imaging studies are generally helpful but can sometimes result in cognitive biases that lead to significant errors. An understanding of the causes of cognitive biases can lead to the development of educational content and systematic improvements that mitigate errors and improve the quality of care provided by radiologists.


Assuntos
Viés , Cognição/fisiologia , Erros de Diagnóstico/psicologia , Diagnóstico por Imagem/psicologia , Heurística/fisiologia , Tomada de Decisões/fisiologia , Humanos
17.
Otolaryngol Head Neck Surg ; 158(6): 989-990, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29584581

RESUMO

Despite the common sense that we learn from our mistakes, an error is an unwelcome event when we deal with patients. Diagnostic error is common, costly, and the leading cause of malpractice litigation. Yet, errors occur occasionally in a lifetime of practice, and the consequences of these faults are significant for patients and physicians. If someone would have told me that I would miss a brain tumor in my first years of practice, in a patient presenting to my care with several cranial nerve signs, I would not have believed it. Here is how it happened.


Assuntos
Erros de Diagnóstico/psicologia , Erros Médicos/psicologia , Médicos/psicologia , Serviço Hospitalar de Emergência , Humanos , Imperícia , Neuroma Acústico/diagnóstico , Exame Físico
19.
BMJ Case Rep ; 20182018 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-29525765

RESUMO

Over the last three decades, the development of systematic and protocol-based algorithms, and advances in available diagnostic tests have become the indispensable parts of practising medicine. Naturally, despite the implementation of meticulous protocols involving diagnostic tests or even trials of empirical therapies, the cause of one's symptoms may still not be obvious. We herein report a case of chronic back pain, which took about 5 years to get accurately diagnosed. The case challenges the diagnostic assumptions and sets ground of discussion for the diagnostic reasoning pitfalls and heuristic biases that mislead the caring physicians and cost years of low quality of life to our patient. This case serves as an example of how anchoring heuristics can interfere in the diagnostic process of a complex and rare entity when combined with a concurrent potentially life-threatening condition.


Assuntos
Aneurisma Aórtico/diagnóstico por imagem , Dor nas Costas/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Diagnóstico Tardio/estatística & dados numéricos , Erros de Diagnóstico/estatística & dados numéricos , Meningioma/diagnóstico por imagem , Tomografia , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Dor nas Costas/etiologia , Dor nas Costas/psicologia , Dor nas Costas/cirurgia , Dor Crônica/etiologia , Dor Crônica/psicologia , Dor Crônica/cirurgia , Diagnóstico Tardio/psicologia , Erros de Diagnóstico/psicologia , Feminino , Heurística , Humanos , Meningioma/complicações , Meningioma/fisiopatologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Dor Intratável , Qualidade de Vida/psicologia , Fatores de Tempo
20.
BMC Pulm Med ; 18(1): 9, 2018 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-29343236

RESUMO

BACKGROUND: The diagnosis of idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILD) presents significant clinical challenges. To gain insights regarding the diagnostic experience of patients with ILD and to identify potential barriers to a timely and accurate diagnosis, we developed an online questionnaire and conducted a national survey of adults with a self-reported diagnosis of ILD. METHODS: A pre-specified total of 600 subjects were recruited to participate in a 40-question online survey. E-mail invitations containing a link to the survey were sent to 16 427 registered members of the Pulmonary Fibrosis Foundation. Additionally, an open invitation was posted on an online forum for patients and caregivers ( www.inspire.com ). The recruitment and screening period was closed once the pre-defined target number of respondents was reached. Eligible participants were adult U.S. residents with a diagnosis of IPF or a non-IPF ILD. RESULTS: A total of 600 eligible respondents met the eligibility criteria and completed the survey. Of these, 55% reported ≥ 1 misdiagnosis and 38% reported ≥ 2 misdiagnoses prior to the current diagnosis. The most common misdiagnoses were asthma (13.5%), pneumonia (13.0%), and bronchitis (12.3%). The median time from symptom onset to current diagnosis was 7 months (range, 0-252 months), with 43% of respondents reporting a delay of ≥ 1 year and 19% reporting a delay of ≥ 3 years. Sixty-one percent of respondents underwent at least one invasive diagnostic procedure. CONCLUSIONS: While a minority of patients with ILD will experience an appropriate and expedient diagnosis, the more typical diagnostic experience for individuals with ILD is characterized by considerable delays, frequent misdiagnosis, exposure to costly and invasive diagnostic procedures, and substantial use of healthcare resources. These findings suggest a need for physician education, development of clinical practice recommendations, and improved diagnostic tools aimed at improving diagnostic accuracy in patients with ILD.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Erros de Diagnóstico/estatística & dados numéricos , Fibrose Pulmonar Idiopática/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/diagnóstico , Bronquite/diagnóstico , Diagnóstico Tardio/psicologia , Erros de Diagnóstico/psicologia , Técnicas de Diagnóstico do Sistema Respiratório/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Qualidade de Vida , Fatores de Tempo , Adulto Jovem
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