Emergency medicine physicians' perspectives on diagnostic accuracy in neurology: A qualitative study

Ava L. Liberman, Natalie T. Cheng, Benjamin W. Friedman, Maya T. Gerstein, Khadean Moncrieffe, Daniel L. Labovitz, Richard B. Lipton

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: We sought to understand the knowledge, attitudes, and beliefs of emergency medicine (EM) physicians towards non-specific neurological conditions and the use of clinical decision support (CDS) to improve diagnostic accuracy. Methods: We conducted semi-structured interviews of EM physicians at four emergency departments (EDs) affiliated with a single US healthcare system. Interviews were conducted until thematic saturation was achieved. Conventional content analysis was used to identify themes related to EM physicians' perspectives on acute diagnostic neurology; directed content analysis was used to explore views regarding CDS. Each interview transcript was independently coded by two researchers using an iteratively refined codebook with consensus-based resolution of coding differences. Results: We identified two domains regarding diagnostic safety: (1) challenges unique to neurological complaints and (2) challenges in EM more broadly. Themes relevant to neurology included: (1) knowledge gaps and uncertainty, (2) skepticism about neurology, (3) comfort with basic as opposed to detailed neurological examination, and (4) comfort with non-neurological diseases. Themes relevant to diagnostic decision making in the ED included: (1) cognitive biases, (2) ED system/environmental issues, (3) patient barriers, (4) comfort with diagnostic uncertainty, and (5) concerns regarding diagnostic error identification and measurement. Most participating EM physicians were enthusiastic about the potential for well-designed CDS to improve diagnostic accuracy for non-specific neurological complaints. Conclusions: Physicians identified diagnostic challenges unique to neurological diseases as well as issues related more generally to diagnostic accuracy in EM. These physician-reported issues should be accounted for when designing interventions to improve ED diagnostic accuracy.

Original languageEnglish (US)
Pages (from-to)225-235
Number of pages11
Issue number2
StatePublished - May 1 2022


  • clinical reasoning
  • diagnostic error
  • emergency medicine
  • semi-structured interviews
  • stroke
  • transient ischemic attack

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Clinical Biochemistry
  • Biochemistry, medical


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