Are Clinicians Correct When They Believe They Are Correct? Implications for Medical Decision Support

Friedman Charles; Gatti Guido; Elstein Arthur; Franz Timothy; Murphy Gwendolyn; Wolf Fredric

doi:10.3233/978-1-60750-928-8-454

Cited by 42Clinical Reasoning and Diagnostic SkillsDecision-Making and Behavioral EconomicsElectronic Health Records Systems

Are Clinicians Correct When They Believe They Are Correct? Implications for Medical Decision Support

Friedman Charles, Gatti Guido, Elstein Arthur, Franz Timothy, Murphy Gwendolyn, Wolf Fredric·2001·Studies in Health Technology and Informatics

DOI 10.3233/978-1-60750-928-8-454

Open this paper in CoChat — free account

Abstract

The process of clinical decision support is linked to the validity of clinicians’ confidence in their judgments. Clinicians who are appropriately confident—highly confident when they are correct and less confident when they are incorrect—will access computer-based and other information resources only when they are needed. Clinicians who are consistently underconfident will rely on external resources when they are not needed. Those who are overconfident, who believe they are correct when in fact they are not, will be prone to medical errors. An extensive literature indicates a general tendency toward overconfidence in human judgment.

Integrity signals

Registry

Crossref · 10.3233/978-1-60750-928-8-454

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Underconfident clinicians are likely to seek external information to validate and ensure their diagnostic accuracy, resulting in over testing and delays in decision making.
“underconfident clinicians are likely to seek external information to validate and ensure their diagnostic accuracy [106,107], resulting in over testing and delays in decision making [108].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [107]

Judgment under Uncertainty: Heuristics and Biases
Tversky, A., & Kahneman, D. (1975) · Utility, Probability, and Human Decision Making · doi:10.1007/978-94-010-1834-0_8 · Cited by 22,650 · see citing works
To Err Is Human
Institute of Medicine (2000) · National Academies Press eBooks · doi:10.17226/9728 · Cited by 14,174 · see citing works
The Design of Everyday Things
Norman, D. A. (2016) · Vahlen eBooks · doi:10.15358/9783800648108 · Cited by 6,390 · see citing works
Do those who know more also know more about how much they know?*1
Lichtenstein, S., & Fischhoff, B. (1977) · Organizational Behavior and Human Performance · doi:10.1016/0030-5073(77)90001-0 · Cited by 1,107 · see citing works
A COMPUTER-ASSISTED MANAGEMENT PROGRAM FOR ANTIBIOTICS AND OTHER ANTIINFECTIVE AGENTS
Vans, R. S. C. E., Estotnik, S. T. L. P., Lassen, D. A. C. C., Lemmer, T., Eaver, L. I. K. W., Rme, J. A. F. O., Loyd, J. A. F. L., & Urke, J. O. P. B. (1998) · Cited by 692 · see citing works
Medical Diagnostic Decision Support Systems--Past, Present, And Future: A Threaded Bibliography and Brief Commentary
Miller, R. A. (1994) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1994.95236141 · Cited by 460 · see citing works
Physicians' use of probabilistic information in a real clinical setting.
Christensen-Szalanski, J. J. J., & Bushyhead, J. B. (1981) · Journal of Experimental Psychology Human Perception & Performance · doi:10.1037//0096-1523.7.4.928 · Cited by 443 · see citing works
Enhancement of Clinicians' Diagnostic Reasoning by Computer-Based Consultation
Friedman, C. P., Elstein, A. S., Wolf, F. M., Murphy, G. C., Franz, T. M., Heckerling, P. S., Fine, P. L., Miller, T. M., & Abraham, V. (1999) · JAMA · doi:10.1001/jama.282.19.1851 · Cited by 219 · see citing works
Physicians' Estimates of the Probability of Myocardial Infarction in Emergency Boom Patients with chest Pain
Tierney, W. M., Fitzgerald, J. F., McHenry, R., Roth, B. J., Psaty, B. M., Stump, D. L., & Anderson, F. K. (1986) · Medical Decision Making · doi:10.1177/0272989x8600600103 · Cited by 138 · see citing works
“Just-in-time” clinical information
Chueh, H. C., & Barnett, G. O. (1997) · Academic Medicine · doi:10.1097/00001888-199706000-00016 · Cited by 121 · see citing works
Clinical event monitoring at the University of Pittsburgh.
D, M. M. W. M., Pankaskie, M. C., Hogan, W. R., Tsui, F.-C., Eisenstadt, S. A., Rodríguez, E., & Vries, J. K. (1997) · PubMed Central · Cited by 20 · see citing works
The Relationship between Diagnostic Accuracy and Confidence in Medical Students.
Mann, D. (1993) · Cited by 13 · see citing works
Building an Expert Critiquing System: ESSENTIAL-ATTENDING
Miller, P. L. (1986) · Methods of Information in Medicine · doi:10.1055/s-0038-1635454 · Cited by 9 · see citing works
Computers And Medical Knowledge: The Diffusion Of Decision Support Technology
Weaver, R. R. (1991) · Cited by 6 · see citing works

Flagged first, then by citations

Sorted by citations

Cognitive biases associated with medical decisions: a systematic review
Saposnik, G., Redelmeier, D., Ruff, C. C., & Tobler, P. N. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0377-1 · Cited by 1,001 · see citing works
Physicians’ Diagnostic Accuracy, Confidence, and Resource Requests: A Vignette Study
Meyer, A. N. D., Payne, V. L., Meeks, D. W., Rao, R., & Singh, H. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.10081 · Cited by 268 · see citing works
Information needs and information‐seeking behaviour analysis of primary care physicians and nurses: a literature review
Clarke, M. A., Belden, J. L., Koopman, R. J., Steege, L. M. B., Moore, J. L., Canfield, S. M., & Kim, M. S. (2013) · Health Information & Libraries Journal · doi:10.1111/hir.12036 · Cited by 198 · see citing works
Do physicians know when their diagnoses are correct?: Implications for decision support and error reduction
Friedman, C. P., Gatti, G. G., Franz, T. M., Murphy, G. C., Wolf, F. M., Heckerling, P. S., Fine, P. L., Miller, T. M., & Elstein, A. S. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.30145.x · Cited by 187 · see citing works
Promoting Self-confidence in Clinical Nursing Students
Lundberg, K. M. (2008) · Nurse Educator · doi:10.1097/01.nne.0000299512.78270.d0 · Cited by 150 · see citing works
Treatment algorithms and protocolized care
Morris, A. H. (2003) · Current Opinion in Critical Care · doi:10.1097/00075198-200306000-00012 · Cited by 124 · see citing works
Do physicians value decision support? A look at the effect of decision support systems on physician opinion
Dreiseitl, S., & Binder, M. (2005) · Artificial Intelligence in Medicine · doi:10.1016/j.artmed.2004.07.007 · Cited by 102 · see citing works
Medical errors and clinical risk management: state of the art.
Pietra, L. L., Calligaris, L., Molendini, L., Quattrin, R., & Brusaferro, S. (2005) · Europe PMC (PubMed Central) · Cited by 77 · see citing works
Heuristic reasoning and cognitive biases: Are they hindrances to judgments and decision making in orthodontics?
Hicks, E. P., & Kluemper, G. T. (2011) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2010.05.018 · Cited by 63 · see citing works
Reliance, trust and heuristics in judgmental forecasting
Alvarado, J., & Barrero, L. H. (2014) · Computers in Human Behavior · doi:10.1016/j.chb.2014.03.047 · Cited by 61 · see citing works
Advancing the research agenda for diagnostic error reduction
Zwaan, L., Schiff, G. D., & Singh, H. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001624 · Cited by 56 · see citing works
Expertise, credibility of system forecasts and integration methods in judgmental demand forecasting
Alvarado, J., Barrero, L. H., Önkal, D., & Dennerlein, J. T. (2016) · International Journal of Forecasting · doi:10.1016/j.ijforecast.2015.12.010 · Cited by 56 · see citing works
Medical Decision Making: A Physician's Guide
Schwartz, A., & BERGUS, G. R. (2008) · DigitalGeorgetown (Georgetown University Library) · doi:10.1017/cbo9780511722080 · Cited by 51 · see citing works
Importance of Building Confidence in Patient Communication and Clinical Skills Among Chiropractic Students
Hecimovich, M. D., & Volet, S. (2009) · Journal of Chiropractic Education · doi:10.7899/1042-5055-23.2.151 · Cited by 48 · see citing works
Student attitudes and their academic performance: is there any relationship?
Liddell, M. J., & Davidson, S. K. (2004) · Medical Teacher · doi:10.1080/01421590310001642993 · Cited by 42 · see citing works
The classification of clinicians' information needs while using a clinical information system.
Allen, M., Currie, L. M., Graham, M., Henry, S. B., Patel, V. L., & Cimino, J. J. (2003) · PubMed · Cited by 32 · see citing works
Overconfident health workers provide lower quality healthcare
Kovacs, R., Lagarde, M., & Cairns, J. (2019) · Journal of Economic Psychology · doi:10.1016/j.joep.2019.102213 · Cited by 28 · see citing works
Analysis of diagnostic confidence and diagnostic accuracy: a unified framework
Ng, C. S., & Palmer, C. (2007) · British Journal of Radiology · doi:10.1259/bjr/64096611 · Cited by 27 · see citing works
Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey
Lakhlifi, C., Lejeune, F., Rouault, M., Khamassi, M., & Rohaut, B. (2023) · Cognitive Research Principles and Implications · doi:10.1186/s41235-023-00474-1 · Cited by 25 · see citing works
Sure, or unsure? Measuring students’ confidence and the potential impact on patient safety in multiple-choice questions
Rangel, R. H., Möller, L., Sitter, H., Stibane, T., & Strzelczyk, A. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1362103 · Cited by 22 · see citing works
Lucky guess or knowledge: a cross-sectional study using the Bland and Altman analysis to compare confidence-based testing of pharmacological knowledge in 3rd and 5th year medical students
Kampmeyer, D., Matthes, J., & Herzig, S. (2014) · Advances in Health Sciences Education · doi:10.1007/s10459-014-9537-1 · Cited by 22 · see citing works
Diagnostic heuristics in dermatology, part 2: metacognition and other fixes
Lowenstein, E. J., & Sidlow, R. (2018) · British Journal of Dermatology · doi:10.1111/bjd.17127 · Cited by 15 · see citing works
Confidence and Information Access in Clinical Decision-Making: An Examination of the Cognitive Processes that affect the Information-seeking Behavior of Physicians.
Uy, R. C. Y., Sarmiento, R. F., Gavino, A., & Fontelo, P. A. (2014) · PubMed Central · doi:10.13140/rg.2.1.3571.8562 · Cited by 15 · see citing works
Confidence Calibration: An Introduction With Application to Quality Improvement
Amini, B., Bassett, R. L., Haygood, T. M., McEnery, K. W., & Richardson, M. L. (2020) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2019.12.009 · Cited by 14 · see citing works
Applying a decision support system in clinical practice: results from melanoma diagnosis.
Dreiseitl, S., Binder, M., Vinterbo, S. A., & Kittler, H. (2007) · PubMed Central · Cited by 13 · see citing works
Tracing the evolution of chiropractic students’ confidence in clinical and patient communication skills during a clinical internship: a multi-methods study
Hecimovich, M. D., & Volet, S. (2012) · BMC Medical Education · doi:10.1186/1472-6920-12-42 · Cited by 10 · see citing works
Residents need competence not confidence: A retrospective evaluation of the new competency education program for Korean neurology residents
Choi, H., Oh, J., Kim, C. K., Ryu, H. B., & Ryu, Y. (2023) · PLoS ONE · doi:10.1371/journal.pone.0290503 · Cited by 7 · see citing works
Acute fasciolosis in an alpaca: a case report
Hayes, C. J., O'Brien, P. J., Wolfe, A., Hoey, S., Chandler, C., Rhodes, V., Carty, C. I., Piras, I. M., & Ryan, E. (2021) · BMC Veterinary Research · doi:10.1186/s12917-021-02921-x · Cited by 7 · see citing works
Through the eyes of the Informationist: Identifying information needs of the Breast Imaging Service at a tertiary medical center specializing in cancer
DeRosa, A. P., Gibson, D. S., & Morris, E. A. (2016) · Health Informatics Journal · doi:10.1177/1460458216642505 · Cited by 7 · see citing works
Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
Yen, C., Epling, J. W., Rockwell, M., & Vaughn-Cooke, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020347 · Cited by 6 · see citing works
Reading and Writing: Qualitative Analysis of Pharmacists' Use of the EHR when Preparing for Team Rounds.
Nelson, S. D., LaFleur, J., Fiol, G. D., Evans, R. S., & Weir, C. R. (2015) · PubMed Central · Cited by 6 · see citing works
Reverse-correlation reveals internal error-corrections during information-seeking
Weise, L., Forster, S. D., & Gauggel, S. (2021) · Metacognition and Learning · doi:10.1007/s11409-021-09286-4 · Cited by 4 · see citing works
Surgeon Confidence in an Outpatient Setting
Hageman, M. G. J. S., Bossen, J. K. J., King, J. D., & Ring, D. (2013) · Hand · doi:10.1007/s11552-013-9533-6 · Cited by 4 · see citing works
Israeli pediatricians’ confidence level in diagnosing and treating children with skin disorders: a cross-sectional questionnaire pilot study
André, N., Muallem, L., Yahav, L., Golan‐Tripto, I., Shmuel, A. B., & Horev, A. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1250271 · Cited by 2 · see citing works
Measure of Healthcare Professionals’ Behavioral Outcomes Using a Social Learning Theory
Bhatti, R., & Naeem, S. B. (2018) · Communications in computer and information science · doi:10.1007/978-3-319-74334-9_53 · Cited by 2 · see citing works
Demigods of Technology Use – How Beating the Overconfidence Bias Can Prevent Medical Errors
Oschinsky, F. M., Müller, M., & Niehaves, B. (2020) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2020.471 · Cited by 1 · see citing works
Attending Surgeons Demonstrate Greater Correlations of Skill Assessment and Anticipation of Adverse Events Than Residents During Laparoscopic Cholecystectomy
Lau, N. K. C., Hartman‐Kenzler, J., Fichtel, E., Park, J., Ponnala, S., Parker, S. H., Fitzgibbons, S., & Safford, S. D. (2021) · Journal of Surgical Research · doi:10.1016/j.jss.2020.12.064 · Cited by 1 · see citing works
Payoff designs in post-decision wagering: a systematic review
Weise, L. (2024) · Metacognition and Learning · doi:10.1007/s11409-024-09411-z · Cited by 1 · see citing works
Differentiating Small (≤1 cm) Focal Liver Lesions as Metastases or Cysts by means of Computed Tomography: A Case-Study to Illustrate a Fuzzy Logic-Based Method to Assess the Impact of Diagnostic Confidence on Radiological Diagnosis
Girometti, R., Fabris, F., Sgarro, A., Zanella, G., Pullini, S., Cereser, L., Como, G., Zuiani, C., & Bazzocchi, M. (2014) · Computational and Mathematical Methods in Medicine · doi:10.1155/2014/587976 · Cited by 1 · see citing works
An Evaluation of a Payer-Based Electronic Health Record in an Emergency Department on Quality, Efficiency, and Cost of Care
Daniel, G. W. (2008) · UA Campus Repository (The University of Arizona)
Use of the isolated elements effect to teach observational gait analysis
Sass, K. J., Schuh, K. L., Alessi, S. M., Barlow, P. B., Moore, J. L., & Yack, H. J. (2016) · doi:10.17077/etd.bilmdkma
Nutzung und Akzeptanz klinischer Entscheidungsunterstützungssysteme - Entwurf eines Modells für die medizinische Lehre
Perlich, A. C. (2022) · doi:10.53846/goediss-9208

Do physicians know when their diagnoses are correct?: Implications for decision support and error reduction
Friedman, C. P., Gatti, G. G., Franz, T. M., Murphy, G. C., Wolf, F. M., Heckerling, P. S., Fine, P. L., Miller, T. M., & Elstein, A. S. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.30145.x · Cited by 187 · see citing works
Do physicians know when their diagnoses are correct?: Implications for decision support and error reduction
Miller, T. M., Franz, T. M., Murphy, G. C., Heckerling, P. S., Wolf, F. M., Gatti, G., Friedman, C. P., Fine, P. L., & Elstein, A. S. (2020) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/bc12-ke43 · Cited by 17 · see citing works
Confidence and certainty in medical diagnoses within acute healthcare: a scoping review
Aiyer, S., Higham, H., & Yeung, N. (2025) · BMJ Quality & Safety · doi:10.1136/bmjqs-2024-017997 · Cited by 5 · see citing works
Evidence of Data and Confidence in Clinical Judgments
Gambara, H., & León, O. G. (1996) · European Journal of Psychological Assessment · doi:10.1027/1015-5759.12.3.193 · Cited by 2 · see citing works
Diagnostic Error: Is Overconfidence the Problem?
Graber, M. L. (2008) · Cited by 11 · see citing works

Authors: Charles, F., Guido, G., Arthur, E., Timothy, F., Gwendolyn, M., & Fredric, W.
Venue: Studies in Health Technology and Informatics
Publisher: IOS Press
Published: 2001
Volume: 84
Issue: Pt 1
Pages: 454-8
ISSN: 0926-9630 (ISSN-L)
DOI: 10.3233/978-1-60750-928-8-454
OpenAlex: W2255803544
Cited by: 41
References: 14
Citations by year: 2024: 1 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 1 · 2014: 4 · 2013: 4 · 2012: 1
FWCI: 8.59
Type: book chapter
Language: en
Open access: closed
Locations: Studies in health technology and informatics (publishedVersion)
PubMed (publishedVersion)
PubMed
Funders: National Institutes of Health (5r01lm005630-06)
U.S. National Library of Medicine (R01-LM-05630)
Topics: Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords: clinical decision support, overconfidence, confidence judgments, diagnostic accuracy, underconfidence, medical errors, differential diagnosis, internal medicine diagnosis, clinical experience, medical students, medical residents, information needs, medical informatics research
MeSH terms: Decision Making, Diagnosis, Internship and Residency, Judgment, Medical Staff, Hospital, Students, Medical, Clinical Medicine, Decision Support Systems, Clinical

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Are Clinicians Correct When They Believe They Are Correct? Implications for Medical Decision Support

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks