Abstract:
OBJECTIVE:This study explores the alignment between physicians' confidence in their diagnoses and the "correctness" of these diagnoses, as a function of clinical experience, and whether subjects were prone to over-or underconfidence. DESIGN:Prospective, counterbalanced experimental design. SETTING:Laboratory study conducted under controlled conditions at three academic medical centers. PARTICIPANTS:Seventy-two senior medical students, 72 senior medical residents, and 72 faculty internists. INTERVENTION:We created highly detailed, 2-to 4-page synopses of 36 diagnostically challenging medical cases, each with a definitive correct diagnosis. Subjects generated a differential diagnosis for each of 9 assigned cases, and indicated their level of confidence in each diagnosis. MEASUREMENTS AND MAIN RESULTS:A differential was considered "correct" if the clinically true diagnosis was listed in that subject's hypothesis list. To assess confidence, subjects rated the likelihood that they would, at the time they generated the differential, seek assistance in reaching a diagnosis. Subjects' confidence and correctness were "mildly" aligned (kappa=.314 for all subjects, .285 for faculty, .227 for residents, and .349 for students). Residents were overconfident in 41% of cases where their confidence and correctness were not aligned, whereas faculty were overconfident in 36% of such cases and students in 25%. CONCLUSIONS:Even experienced clinicians may be unaware of the correctness of their diagnoses at the time they make them. Medical decision support systems, and other interventions designed to reduce medical errors, cannot rely exclusively on clinicians' perceptions of their needs for such support.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Friedman CP,Gatti GG,Franz TM,Murphy GC,Wolf FM,Heckerling PS,Fine PL,Miller TM,Elstein ASdoi
10.1111/j.1525-1497.2005.30145.xsubject
Has Abstractpub_date
2005-04-01 00:00:00pages
334-9issue
4eissn
0884-8734issn
1525-1497pii
JGI30145journal_volume
20pub_type
杂志文章,多中心研究abstract:BACKGROUND:Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians' attitudes towards this new medical practice has been largely neglected. OBJECTIVE:To identify facilitators and barriers to the potential or actual impl...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0881-9
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To determine the relevance of the initial certifying examination to the practice of internal medicine and the suitability of items used in initial certification for recertification. DESIGN:Using a matrix-sampling approach, items from the 1991 Certifying Examination were assigned to two sets of judges: direct...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599989
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use. PARTICIPANTS:A nationally representative sample of Medicare beneficiaries, who participated in the Medicare Current Beneficiary Survey (MCBS)...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1788-4
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription. OBJECTIVE:To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 mon...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4628-y
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Screening patterns among primary care physicians (PCPs) may be influenced by patient age and comorbidity. Colorectal cancer (CRC) screening has little benefit among patients with limited life expectancy. OBJECTIVE:To characterize the extent to which PCPs modify their recommendations for CRC screening based ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2093-6
更新日期:2013-01-01 00:00:00
abstract::Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care team, recognizes and meets the majority of each patient's physical and mental health care needs) is an important element of primary care, but seems to be declining in the U.S. This is concerning, because more comprehensiv...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3300-z
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:To assess the effect of a program that encourages teamwork between physicians and pharmacists on attempts to lower total cholesterol levels and to meet recommended goals proposed by the National Cholesterol Education Program (NCEP). DESIGN:A single-blind, randomized, controlled trial lasting 6 months. SETTI...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s11606-006-5023-7
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:Online learning has changed medical education, but many "educational" websites do not employ principles of effective learning. This article will assist readers in developing effective educational websites by integrating principles of active learning with the unique features of the Web. DESIGN:Narrative revie...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2004.30029.x
更新日期:2004-06-01 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) is a primary care delivery model predicated on shared responsibility for patient care among members of an interprofessional team. Effective task sharing may reduce burnout among primary care providers (PCPs). However, little is known about the extent to which PCPs sha...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-017-4188-6
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis. We performed a systematic review of the literature to determine the efficacy of antibiotics for smokers with acute bronchitis. DESIGN:A medline search was done using the keywords bronchitis, cough,...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.2002.10405.x
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care. OBJECTIVE:To test the effectiveness of portal and IVR outreach in improving rates of influenza...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-017-4266-9
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To study an office-based strategy for increasing influenza vaccine delivery to high-risk patients at a university hospital general medicine practice. DESIGN:Historically controlled study of physician practices in an outpatient general medicine setting. SETTING:A group practice with two separate offices: a f...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599008
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Healthcare providers use a life expectancy of at least 5 to 10 years in shared clinical decision-making with older adults about cancer screening, major surgeries, and disease prevention interventions. At present, few prognostic indexes predict long-term mortality beyond 10 years or are suited for use in prim...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06132-2
更新日期:2020-08-20 00:00:00
abstract:BACKGROUND:Prior studies have demonstrated how price transparency lowers the test-ordering rates of trainees in hospitals, and physician-targeted price transparency efforts have been viewed as a promising cost-controlling strategy. OBJECTIVE:To examine the effect of displaying paid-price information on test-ordering r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-016-3917-6
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use. OBJECTIVE:To determine how patients' deductible levels and socioeconomic status may affect primary care physicians' recommendations for colorectal cancer sc...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0714-x
更新日期:2008-10-01 00:00:00
abstract::The clinical presentation of lead intoxication may vary widely and in the absence of a high clinical index of suspicion, the diagnosis may be missed. The effects of lead on mitochondrial oxidative phosphorylation and its interaction with calcium-mediated processes explain the heterogenous presentation. In this case re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00328.x
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centered outcomes. OBJECTIVE:To understand the facilitators that contributed to the success of the Primary Palliative Care for Emergency Medicine (PRIM-ER) quality improvement pilot in...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06302-2
更新日期:2020-10-27 00:00:00
abstract:BACKGROUND:The patient-centered medical home (PCMH) model has several components to improve care for patients with high comorbidity, including greater access to face-to-face primary care. OBJECTIVE:We examined whether high-comorbidity patients had larger increases in primary care provider (PCP) visits attributable to ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3833-9
更新日期:2016-12-01 00:00:00
abstract::General Internal Medicine research evolves in response to the needs of the patients to whom we provide care. Currently, many studies exclude older adults who deeply affect the clinical care of this population. With the number of older adults increasing, creating research protocols that include older adults with multip...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2719-3
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Medical student interest in internal medicine is decreasing. Whether the internal medicine sub-internship affects intent to pursue internal medicine is unknown. OBJECTIVE:Determine the immediate and longer-term effect of the medicine sub-internship on students' decision to pursue internal medicine residency...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1263-7
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES:(1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine i...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2516-z
更新日期:2013-12-01 00:00:00
abstract::Increasingly, oncology practitioners are realizing that despite the "success" of cancer therapies, cancer survivors are facing previously unrecognized issues related to survivorship, including physical and psychosocial side-effects of the cancer and its treatment, second cancers, and practical and economic issues rela...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-009-1010-0
更新日期:2009-11-01 00:00:00
abstract::Reflective capacity has been described as an essential characteristic of professionally competent clinical practice, core to ACGME competencies. Reflection has been recently linked to promoting effective use of feedback in medical education and associated with improved diagnostic accuracy, suggesting promising outcome...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1347-4
更新日期:2010-07-01 00:00:00
abstract::Evaluations of intensive care have largely focused on survival, cost, or functional status; however, these may not be the only outcomes of interest to patients, families, and health care providers. Quality of life is an important consideration in evaluating intensive care because it influences decisions about the use ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596335
更新日期:1988-05-01 00:00:00
abstract:OBJECTIVE:To determine patient knowledge about life-sustaining treatments and physician understanding of patient preferences for proxies and treatments after outpatient discussions about advance directives. DESIGN:Cross-sectional interview-based and questionnaire-based survey. SETTING:Two university general internal ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00133.x
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:In the 27 nursing homes located within the Veterans Affairs (VA) Central Region, the proportion of residents with pressure ulcers in 1986 varied from 2% to 16%. Three of these nursing homes were selected for study: nursing home A from the highest prevalence quintile, B from close to the median, and C from th...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598281
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVE:Determine patient and hospital-level variation in proportions of low-severity admissions. DESIGN:Retrospective cohort study. SETTING:Thirty hospitals in a large metropolitan region. PATIENTS:A total of 43,209 consecutive eligible patients discharged in 1991 through 1993 with congestive heart failure (n = 2...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1046/j.1525-1497.1997.00073.x
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes. OBJECTIVE:To examine the effect of isolation precautions on hospital-related outcomes and c...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-016-3862-4
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:The use of coronary computed tomographic angiography (CCTA) for evaluation of patients with suspected coronary artery disease (CAD) is growing rapidly, yet questions remain regarding its diagnostic accuracy and its impact on clinical decision-making and patient outcomes. METHODS:A systematic literature revi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1556-x
更新日期:2011-03-01 00:00:00
abstract::Sarcoidosis is a multisystem disease of unknown etiology. Renal manifestation is rare and usually caused by hypercalcemia and nephrocalcinosis. Moreover, renal disease can occur as granulomatous interstitial nephritis (GIN), which is a histological diagnosis. We describe a case of sarcoidosis first presenting with mul...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0603-3
更新日期:2008-06-01 00:00:00