Doctors Often Overestimate Their Expertise
Studies suggest more outside evaluation is needed
TUESDAY, Sept. 5, 2006 (HealthDay News) -- Doctors often have a falsely exaggerated view of their own capabilities, a new study suggests.
In fact, physicians who were judged by outsiders to be the worst performers in a given area often gave themselves especially high marks, researchers report.
"There is a subset of clinicians who appear, either by training or personality, unable to judge themselves," said study lead researcher Dr. David Davis, a professor of health policy management and evaluation at the University of Toronto, in Canada.
The findings suggest that outside evaluators might be better equipped to review a physician's performance, then direct him or her to areas that need improvement with continuing medical education.
Right now, those decisions are left up to the individual doctor. But, "we need to have systems that inform physicians about what they know and don't know," Davis said.
His team published its findings in the Sept. 6 issue of the Journal of the American Medical Association.
More than almost any other profession, doctors are engaged in ongoing, lifelong training in the form of continuing medical education, or CME. In fact, medical boards require that doctors engage in regular CME for their re-certification. This training refreshes a doctor's skills while keeping them up-to-date on the latest innovations in medicine.
But, in most cases, doctors decide what their particular areas of weakness might be.
In their review, Davis and his colleagues in Canada and the United States decided to see what the accumulated data had to say about the accuracy of physician self-assessments. To do so, they focused on 17 studies comparing doctors' self-assessments against those of an objective, external reviewer.
"In two-thirds of those studies, it appears as though physicians, without any outside means of observing their behavior, misjudged their competence," Davis said.
In many cases, doctors thought they were very adept in certain tasks -- detecting signs of sexual abuse in patients, for example, or delivering joint injections -- but were typically deemed to be poor performers by outside experts.
Davis said the findings shouldn't come as a big surprise to anyone familiar with human nature.
"This isn't peculiar to physicians," he said. "It's peculiar to us all as human beings. It's just part of the human condition that we don't have full, objective opinions of ourselves." In fact, he added, studies have found similar trends among lawyers, engineers and other professionals.
The solution, experts say, is a greater reliance on outside evaluation in helping doctors decide what to focus on in ongoing CME.
Davis pointed to one such system now in wide use throughout Great Britain.
"It's called the appraisal system, in which peer physicians sit down with a colleague, go through some charts, and say, 'You know, as a GP, you seem to be very skilled in geriatrics or pediatrics, but I wonder about obstetrics?' for example," Davis said. That doctor would then be recommended to concentrate on obstetrics in his or her next round of CME.
Another expert agreed that the findings highlight a common failing among doctors.
"We are often overly confident when we don't know much about [a subject]," said Dr. Daniel Duffy, executive vice president of the American Board of Internal Medicine, based in Philadelphia.
Duffy, who also co-authored an editorial in JAMA on the study findings, said there are tools that can help physicians get a more objective view of their strengths and weaknesses. The American Board of Internal Medicine, for example, uses what's known as a "practice improvement module."
This program "simply looks over a sample of patients from the [doctor's] practice and collects data about the quality of care they are receiving," Duffy explained. "What the doctor gets is a snapshot of his or her practice. That's a very powerful tool for doctors."
Duffy said patients shouldn't be unduly worried by the new findings.
"I don't think it's cause for alarm, but it is cause for awareness -- on both the part of the doctor and the patient," he said. "I think it is perfectly reasonable, too, to engage doctors in a debate about the doctor's own education and how they are keeping abreast of things."
Doctors may also need more help in dealing with patients who do not speak English, according to a second study published in this week's JAMA.
The survey of more than 2,000 resident physicians receiving training in U.S. hospitals found that more than half were unaware that access to a trained interpreter is now a legal right for U.S. patients with limited English.
Eighty-four percent of these budding doctors said they often turned to bilingual members of the patient's family -- including young children -- as go-betweens during doctor-patient conversations.
"Lack of appropriate medical interpreters not only makes it harder to make the right diagnostic and treatment choices, it also can make care more costly, since studies have shown that providers tend to order more tests in these instances," co-researcher Dr. Joseph Betancourt, of Massachusetts General Hospital in Boston, said in a prepared statement.
For guidelines on choosing a physician, visit the National Institute on Aging.