Strong Link Between a Physician's Diagnostic Knowledge and Likelihood of Patient Death, ED visits or Hospitalizations, Study Says

Philadelphia, PA – Patients are significantly less likely to face death, an emergency department (ED) visit or hospitalization for conditions at high risk for diagnostic errors when treated by a board certified physician who scores higher on diagnostic questions on the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam, according to a study by researchers from ABIM, Harvard Medical School and the Mayo clinic.

The study, published in BMJ Open on April 1, focused on 13 conditions that had been identified as high risk for diagnostic error in a previous study: pulmonary embolism, acute coronary syndrome, stroke, congestive heart failure, fracture, abscess, pneumonia, aortic aneurysm/dissection, appendicitis, depression, anemia, bacteremia/sepsis and spinal cord compression.

After looking at more than 1400 exam results, ABIM found that patients presenting with symptoms related to these conditions who were treated by physicians who scored in the top versus bottom third on MOC diagnosis questions had a 30% lower risk of all-cause mortality and about a 40% lower risk of hospitalization or ED visits for one of these conditions.

"In an era when people think that Google, electronic health record systems and artificial intelligence have rendered differences in physician knowledge irrelevant in terms of patient outcomes, our study shows that the fundamental quality of a physician's diagnostic knowledge base is critically important," said Bradley M. Gray, PhD, lead author of the study. "ABIM recognizes how this knowledge directly translates into better patient care, and that's why more than half of all questions on each exam focus on diagnostic knowledge."

Dr. Bruce Landon, a collaborator from Harvard Medical School, adds, "identifying and studying diagnostic errors has been extremely difficult using existing research methods. This study used a newly developed method to focus on the care of patients whose presenting symptoms were prone to diagnostic error. Our results suggest that diagnostic knowledge measured in an ABIM exam is an important predictor of serious outcomes in these situations and this study is the first to link physician knowledge with outcomes in this way."

ABIM studied the exam results of general internists initially certified by ABIM in 2000, who took the internal medicine MOC exam between 2008-2011. Physicians' scores on the diagnostic questions, which make up more than half of the exam, were compared to their real-world diagnosis of new visits by 42,407 Medicare beneficiaries who presented with symptoms related to the 13 acute conditions prone to diagnostic error.

For every 1,000 visits for a new complaint at risk for diagnostic error, being seen by a physician in the top versus bottom third of diagnostic knowledge was associated with 2.9 fewer deaths from all causes and, for diagnostic error sensitive conditions, 4.1 fewer hospitalizations and 4.9 fewer ED visits within 90 days, according to the study.

Read more research from ABIM and other organizations about board certification, MOC and physician assessment.

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ABIM Board Certified Doctors Make a Difference
Internists and subspecialists who earn and maintain board certification from the American Board of Internal Medicine (ABIM) differentiate themselves every day through their specialized knowledge and commitment to continual learning in service of their patients. Established as an independent nonprofit more than 80 years ago, ABIM continues to be driven by doctors who want to achieve higher standards for better care in a rapidly changing world. Visit ABIM's blog to learn more and follow ABIM on Facebook, Twitter and Instagram. ABIM is a member of the American Board of Medical Specialties.