Our research

Improving the diagnostic process

Second opinions and a patient approach

Emergency departments are places where decisions and communication happens under intense pressure. When it comes to the diagnostic process, clinicians and patients have one thing in common – they’re humans, and bring with them cognitive biases that can affect their thinking and decision-making. 


BehaviourWorks is working with the VMIA (the Victorian Managed Insurance Authority) on developing interventions to reduce diagnostic error in emergency departments and has recently published a paper reviewing three key areas of research to inform the development of interventions; academic evidence, practitioner insights and patient perspectives.   


There is often a translation gap between the academic literature and what happens in practice. This study included nine systematic reviews, as well as six practice interviews and a citizen’s panel to fully understand all perspectives on the challenges of diagnosis.  It’s recognised that while patients are at the heart of the whole process, their expertise (on themselves) can sometimes be overlooked in the high-pressure environment of an emergency department.


By triangulating these three perspectives, we identified a number of suggestions for improvement, including;   




  • Education – training clinicians for specific conditions, cognitive biases and critical reasoning were seen as key, as well as overall training in better communication skills.  Education was the only intervention which was identified by all three perspectives.




  • Seeking second opinions has been effective at reducing diagnostic error.




  • Decision aids, which can help guide clinician’s diagnostic reasoning, and




  • Patients are a critical source of information in the diagnostic process (but are rarely included in a consistent way).




Overall, the academic evidence and practitioners mostly supported interventions to improve clinical reasoning skills and teamwork. The citizens favoured better communication skills.


You can read the abstract and access the full paper (paywalled) here.  

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