“My confidence in the diagnosis is low, but I am confident in what needs to happen for the patient”: a mixed-methods study exploring diagnostic confidence and its impact on physician well-being

Objectives: 

Uncertainty is inherent in diagnostic decision-making. While diagnostic uncertainty research continues to grow, research on diagnostic confidence remains underexplored. Research often uses simplified tools to measure confidence, overlooking the nuanced perspectives of physicians and leaving a limited understanding of the role confidence plays in the diagnostic process. We conducted a mixed-methods study to better understand diagnostic confidence, and ways confidence (or a lack thereof) impacts physicians’ well-being. 

Methods:

In this mixed-methods study, 20 semi-structured virtual interviews were conducted with practicing physicians across 16 hospitals. Participants reflected on cases where they felt “really” confident and “not-so-confident” in their final diagnoses. Confidence scales were included in the interviews to obtain quantitative measures of participants’ confidence in their final diagnoses and in their diagnostic processes for both cases discussed.

Results: 

Physicians conceptualize and report confidence differently for their final diagnoses compared to confidence in their diagnostic approaches. We found that physicians could maintain high levels of confidence in their diagnostic approaches, even in cases with considerable uncertainty in the final diagnoses. Additionally, our results showed that confidence in the diagnostic approach reflected more positively on physician well-being.

Conclusions: 

While physicians often feel uncertainty about their final diagnoses, they are better able to deal with this uncertainty if they are confident in the diagnostic approaches. Studying confidence in the diagnostic approach is key not only for obtaining a more complete understanding of the cognitive processes involved in diagnostic decision-making but also for improving physician well-being.