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114 Let’s talk options: exploring the role of SDM in diagnosis through an analysis of malpractice claims in general practice
  1. Sofie Jacobse1,2,
  2. Hanneke Rijkels-Otters1,
  3. Manon Eikens-Jansen3,
  4. Trudy van der Weijden4,
  5. Glyn Elwyn5,
  6. Walter van den Broek1,
  7. Patrick Bindels1,
  8. Laura Zwaan2
  1. 1Department of General Practice, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Institute of Medical Education Research Rotterdam (iMERR), Rotterdam, The Netherlands
  3. 3VvAA, Orteliuslaan 750, 3528BB Utrecht, The Netherlands
  4. 4Department of Family Medicine, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands
  5. 5The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA

Abstract

Introduction Shared decision-making (SDM) is considered the preferred communication model for medical decisions under conditions of uncertainty, yet it is not commonly used in the diagnostic process. Our aim is to analyze diagnostic malpractice claims and to consider diagnostic decision types where SDM may be of value.

Methods A retrospective observational study in which a database with closed diagnostic malpractice claims (2012–2020) against general practitioners from the largest Dutch liability insurance company was used. We established SDM-selection criteria, specified for the diagnostic process (i.e. diagnostic uncertainty, multiple options, and clinical equipoise). Phase 1: the selected claims from the claim database were categorized using ICPC-3. Phase 2: for a heterogeneous subset of 90 claims the full claim records were reviewed. Arguments related to the diagnostic process from GPs, patients and their legal representatives were extracted and thematically analyzed using an inductive approach. The identified themes were used to formulate diagnostic decision types.

Results Phase 1: 261 out of 1477 claims (18%) met the diagnostic SDM-criteria and were categorized into 10 chapters and 53 separate codes of the ICPC-3. The most frequent diagnostic errors were: fracture (49%), malignancy (10%), infection (9%), tendon rupture (8%) and cardiovascular disease (4%). Phase 2: Twenty themes were identified, based on which five decision types were formulated: ‘White raven’, ‘Time will tell’, ‘Minimal gain’, ‘Still on board?’ and ‘What’s next?’

Discussion This is the first study to use a data driving approach to study the role for SDM in the diagnostic process. The in- depth claim analysis provides a unique insight into the perceptions of patients and GPs.

Conclusion There is a potential role for SDM in a variety of clinical situations within the diagnostic process. The five decision types may help physicians to detect diagnostic situations in practice where SDM can be used.

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