Variations in GPs' decisions to investigate suspected lung cancer: a factorial experiment using multimedia vignettes.

Sheringham J, Sequeira R, Myles J, et al. BMJ Qual Saf. 2016 Sep 20; [Epub ahead of print].

Diagnostic error is common in the primary care setting, with a recent study estimating that 5% of adults in the United States experience a diagnostic error each year. Missed and delayed diagnoses of cancer are a major source of diagnostic error in primary care and account for a large proportion of malpractice lawsuits. This study used detailed, video-based clinical vignettes to analyze how primary care physicians in the United Kingdom chose to initiate the diagnostic workup for lung cancer in patients presenting with a variety of symptoms. The investigators found that clinicians did not consistently pursue further testing in patients with high-risk symptoms, particularly when they failed to elicit additional information from the patient. A recent study found that electronic triggers increased the rate of appropriate workup in patients with suspected cancer, indicating the potential for decision support systems to reduce diagnostic error.

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