We should overcome the barriers to evidence-based clinical diagnosis!

Abstract

Background: The wise integration of evidence from health care research into diagnostic decisions could influence patient outcomes by improving clinical diagnosis, reducing unnecessary testing, and minimizing diagnostic error. Yet for many, this promise does not match reality. Here, we collect and categorize barriers to the use of health care research evidence in diagnostic decisions, examine their potential consequences, and propose potential ways to overcome these impediments. Methods: Barriers were derived from observations over years of trying to inform clinical diagnoses with research evidence, and from interpretations of the literature. Results: Barriers are categorized into those related to the evidence itself, those related to diagnosticians, and those related to health care systems. Tentative solutions are proffered. Data are lacking on the frequency and impact of the identified barriers, as well as on the effectiveness of the proposed solutions. Conclusions: Barriers to the sensible use of evidence from health care research in clinical diagnosis can be identified and categorized, and possible solutions can be imagined. We could, and should, muster the will to overcome these barriers. © 2007 Elsevier Inc. All rights reserved.