Decision making of clinical teams: Communication patterns and diagnostic error

This study examined the discussion of information among mixed-status clinic al teams while constructing differential diagnoses. Twenty-four ad hoc team s, each consisting of a resident, an intern, and a third-year medical stude nt, were given two hypothetical patient cases to discuss and diagnose. Prio r to discussion, team members individually viewed different versions of a v ideotaped interview with a "patient" (trained actor). Each videotape contai ned some information that was present in all three versions (shared informa tion) and some that was present in only that version (unique information). In addition, half of the time, the cases were constructed so that the uniqu e information that appeared in only one tape was crucial for a correct diag nosis (a "hidden profile" condition). After viewing the videotapes, team me mbers met to discuss the case and develop a differential diagnosis. Discuss ions were videotaped and analyzed. Overall, shared information was mentione d more often than unique information (p < 0.0001). Furthermore, teams offer ed incorrect diagnoses significantly more often for hidden-profile cases th an for control cases (p < 0.01). The teams' overreliance on previously shar ed information (inability to appropriately utilize unique information) was detrimental when a correct diagnosis demanded the inclusion of such informa tion. Clinical discussions that require the consideration of uniquely held information may be susceptible to error.