A 35-Year-Old Man Who Fell From a Motorcycle

Joe Nemeth, MD, CCFP(EM); Catherine Patocka, MDCM; David Barbic, MD, MSc


March 30, 2016

A final source of error described by both Croskerry and Norman[9] and Berner and Graber[2] is overconfidence. These researchers advance the notion that clinicians in general underappreciate the likelihood that their diagnoses may be wrong. They cite a lack of clinician-demonstrated knowledge-seeking behavior and failure to adhere to guideline-recommended best practices as indirect indicators of overconfidence.

Concrete and definite evidence of overconfidence has been demonstrated in several studies.[12,13] Podbregar and colleagues[14] asked intensive care unit (ICU) clinicians to provide a clinical diagnosis and their level of uncertainty for 126 patients who had died in the ICU.[14] The uncertainty was measured by three levels: Level 1 represented complete certainty, level 2 represented minor uncertainty, and level 3 was major uncertainty. The discrepancy between the clinical and postmortem diagnoses was identical in all the groups. Similar results were found by Landefeld and colleagues.[15] Clearly, overconfidence plays a role in medical errors; the difficulty lies in developing reasonable strategies to reduce these errors.

Practical solutions to ensure quality patient care are dependent on adapting a systems approach to error reduction, as well as individual clinicians becoming cognizant of their own clinical thought processes. Hospitals and health systems need to adapt approaches that promote individual and departmental excellence. This process is enhanced by using some of the following steps in daily practice:

  • The clinician should regularly step back from a problem and assess how the current thought process has led to the conclusion.

  • The clinician should engage in regular review and feedback activities in order to identify possible sources of error (ie, morbidity and mortality rounds).

  • The clinician should engage in periodic evaluation of his or her practice habits and trends in order to look for possible sources of error in their own practice methods.


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