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临床牙科教员对诊断错误的认知及如何避免这些错误。

Clinical Dental Faculty Members' Perceptions of Diagnostic Errors and How to Avoid Them.

作者信息

Nikdel Cathy, Nikdel Kian, Ibarra-Noriega Ana, Kalenderian Elsbeth, Walji Muhammad F

机构信息

Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston.

出版信息

J Dent Educ. 2018 Apr;82(4):340-348. doi: 10.21815/JDE.018.037.

Abstract

Diagnostic errors are increasingly recognized as a source of preventable harm in medicine, yet little is known about their occurrence in dentistry. The aim of this study was to gain a deeper understanding of clinical dental faculty members' perceptions of diagnostic errors, types of errors that may occur, and possible contributing factors. The authors conducted semi-structured interviews with ten domain experts at one U.S. dental school in May-August 2016 about their perceptions of diagnostic errors and their causes. The interviews were analyzed using an inductive process to identify themes and key findings. The results showed that the participants varied in their definitions of diagnostic errors. While all identified missed diagnosis and wrong diagnosis, only four participants perceived that a delay in diagnosis was a diagnostic error. Some participants perceived that an error occurs only when the choice of treatment leads to harm. Contributing factors associated with diagnostic errors included the knowledge and skills of the dentist, not taking adequate time, lack of communication among colleagues, and cognitive biases such as premature closure based on previous experience. Strategies suggested by the participants to prevent these errors were taking adequate time when investigating a case, forming study groups, increasing communication, and putting more emphasis on differential diagnosis. These interviews revealed differing perceptions of dental diagnostic errors among clinical dental faculty members. To address the variations, the authors recommend adopting shared language developed by the medical profession to increase understanding.

摘要

诊断错误日益被视为医学中可预防伤害的一个来源,但对于其在牙科领域的发生情况却知之甚少。本研究的目的是更深入地了解临床牙科教员对诊断错误的看法、可能发生的错误类型以及可能的促成因素。作者于2016年5月至8月在美国一所牙科学院对十位领域专家进行了半结构化访谈,了解他们对诊断错误及其原因的看法。通过归纳过程对访谈进行分析,以确定主题和关键发现。结果显示,参与者对诊断错误的定义各不相同。虽然所有人都指出了漏诊和误诊,但只有四名参与者认为诊断延迟是一种诊断错误。一些参与者认为只有当治疗选择导致伤害时才会发生错误。与诊断错误相关的促成因素包括牙医的知识和技能、没有花足够的时间、同事之间缺乏沟通以及认知偏差,如基于以往经验的过早定论。参与者提出的预防这些错误的策略包括在调查病例时花足够的时间、组建学习小组、加强沟通以及更重视鉴别诊断。这些访谈揭示了临床牙科教员对牙科诊断错误的不同看法。为解决这些差异,作者建议采用医学专业制定的共享语言以增进理解。

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