Misdiagnosis, Missed Diagnosis, and Delayed Diagnosis of Lupus: A Qualitative Study of Rheumatologists

Objective Diagnostic errors in outpatient settings lead to significant consequences, especially in rare diseases such as systemic lupus erythematosus (SLE). A recent vignette‐based experimental study revealed that demographic factors influenced rheumatologists’ diagnoses of SLE, raising concerns abo...

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Published inArthritis care & research (2010) Vol. 76; no. 11; pp. 1566 - 1573
Main Authors Bane, Shalmali, Falasinnu, Titilola, Espinosa, Patricia Rodriguez, Simard, Julia F.
Format Journal Article
LanguageEnglish
Published Boston, USA Wiley Periodicals, Inc 01.11.2024
Wiley Subscription Services, Inc
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Summary:Objective Diagnostic errors in outpatient settings lead to significant consequences, especially in rare diseases such as systemic lupus erythematosus (SLE). A recent vignette‐based experimental study revealed that demographic factors influenced rheumatologists’ diagnoses of SLE, raising concerns about potential diagnostic biases. We conducted a qualitative study to contextualize these results to generate insights about diagnostic challenges and biases, and root causes. Methods We conducted 41 semistructured interviews among US rheumatologists. Transcripts were independently coded by at least two coders using a hybrid deductive–inductive approach and thematic analysis. A team of four researchers reviewed and defined themes collectively, and also resolved any discrepancies. Results Participants were 66% women, and 49% had more than10 years of postfellowship experience. Five major themes were generated, including receiving training through the lens of race or sex, the role of the documented epidemiology of SLE, pattern recognition and test‐taking strategies, patient vignettes as an imperfect proxy for patient interactions, and varied consequences to patients from diagnostic bias. Participants noted that the consequences of diagnostic bias could include progressed disease from delayed diagnosis, unnecessary and inappropriate treatment due to missed diagnosis or misdiagnosis, and increased cost and harm. Conclusion This study underscores the unique challenges of diagnosing SLE, with complex factors contributing to diagnosis bias and delays. Interventions during medical education could prevent downstream diagnostic biases. Future research should explore interventions to mitigate diagnostic bias and refine vignettes to better mirror real‐world clinical scenarios. Understanding diagnostic bias in SLE is crucial for improving patient outcomes and refining medical training practices.
Bibliography:Author disclosures and graphical abstract are available at
The contents if this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
https://onlinelibrary.wiley.com/doi/10.1002/acr.25405
Additional supplementary information cited in this article can be found online in the Supporting Information section
Supported by the NIH National Institute of Allergy and Infectious Diseases (grant R01‐AI‐154533). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.25405
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ISSN:2151-464X
2151-4658
2151-4658
DOI:10.1002/acr.25405