Accuracy of Practitioner Estimates of Probability of Diagnosis Before and After Testing

• DOI: 10.1001/jamainternmed.2021.0269
• Publication Date: 2021-04-05T15:01:37Z
• Authors: Daniel J. Morgan; Lisa Pineles; Jill Owczarzak; Larry Magder; Laura Scherer; Jessica P. Brown; Chris Pfeiffer; Chris Terndrup; Luci Leykum; David Feldstein; Andrew Foy; Deborah Stevens; Christina Koch; Max Masnick; Scott Weisenberg; Deborah Korenstein
• Keywords: Interquartile range

Accurate diagnosis is essential to proper patient care.To explore practitioner understanding of diagnostic reasoning.In this survey study, 723 practitioners at outpatient clinics in 8 US states were asked estimate the probability disease for 4 scenarios common primary care (pneumonia, cardiac ischemia, breast cancer screening, and urinary tract infection) association positive negative test results with from June 1, 2018, November 26, 2019. Of these practitioners, 585 responded survey, 553 answered all questions. An expert panel developed determined correct responses based on literature review.A total (290 resident physicians, 202 attending 61 nurse physician assistants) (76.5%) fully completed (median age, 32 years; interquartile range, 29-44 293 female [53.0%]; 296 [53.5%] White). Pretest was overestimated scenarios. Probabilities after as follows: pneumonia radiology results, 95% (evidence 46%-65%; comparison P < .001); mammography 50% 3%-9%; ischemia stress result, 70% 2%-11%; infection urine culture 80% 0%-8.3%; .001). Overestimates also observed radiography 10%-19%; 5% <0.05%; 0.43%-2.5%; 0%-0.11%; Probability adjustments response varied accurate overestimates risk by type (imputed median likelihood ratios [LRs] chest pneumonia: LR, 4.8; evidence, 2.6; 0.3; cancer: 44.3; evidence 13.0-33.0; 1.0; 0.05-0.24; exercise ischemia: 21.0; 2.0-2.7; 0.6; 0.5-0.6; infection: 9.0; 0.1; 0.1).This study suggests that diseases tests, overestimate before testing. scenarios, whereas adjustment a or result test. Widespread likely contribute overdiagnosis overuse.