Article Abstract

Christensen, C., Larson, J. R., Jr.,  Abbott, A., Ardolino, A., Franz, T. M., & Pfeiffer, C. (2000).  Decision Making of Clinical Teams: Communication Patterns and Diagnostic Error.  Medical Decision Making, 20, 45-50.

.  This study examined the discussions of mixed-status clinical teams while constructing differential diagnoses.  Twenty-four ad hoc teams, each consisting of a resident, an intern, and a third-year medical student, were given two hypothetical patient cases to discuss and diagnose.  Prior to discussion, team members individually viewed different versions of a videotaped interview with a 'patient' (trained actor).  Each videotape contained some information that was present in all three versions (shared information) and some that was present in only that one version (unique information).  In addition, half of the time, the cases were constructed so that the unique information that appeared in only one tape was crucial for a correct diagnosis (a "hidden profile" condition).  After viewing the videotapes, team members met to discuss the case and develop a differential diagnosis.  These discussions were videotaped.  Overall, shared information was mentioned significantly more often than unique information.  Furthermore, teams offered incorrect diagnoses significantly more often for hidden-profile cases than for control cases.  The teams' overreliance on previously shared information (inability to appropriately utilize unique information) was detrimental when a correct diagnosis demanded the inclusion of such information.  Clinical discussions that require the consideration of uniquely held information may thus be susceptible to error.