"If I see a patient and then later, that patient shows up in the ED, the institution could tell the doctor that and provide feedback on a missed opportunity for learning," Singh says. "Maybe last month one doctor had four patients who ended up in the ED. And over time, the doctor's thinking readjusts and would get better."
Singh emphasizes that no one really knows how accurate internal medicine physicians are at diagnosing their patients during the course of their practice, although estimates tend to hover around 85% to 90%. A15% error rate, however, is large enough to be a worrisome concern.
The accuracy rates in this research project were lower because these cases were more unusual, and because for most internists, "their day-to-day practice is colds and coughs, diarrhea, bellyaches, pneumonia, and heart failure," Singh says. These tougher cases were not, however, beyond the scope of the typical internal medicine practice.
He adds that physicians may express higher levels of confidence, whether they truly are that sure of their opinions, in part because "of something that's ingrained—what we call the hidden curriculum—" learned in medical school.