Prospective analysis of clinician accuracy in the diagnosis of benign anal pathology: comparison across specialties and years of experience

Abstract

Purpose: The majority of patients referred to a colorectal surgeon with anal complaints are told they have "hemorrhoids"; however, many of these patients have other anal pathology causing their symptoms. Therefore, we prospectively evaluated the diagnostic accuracy of physicians for common anal pathology, stratified by specialty and experience.

Methods: Seven common benign anal pathologic conditions were selected (prolapsed internal hemorrhoid, thrombosed external hemorrhoid, abscess, fissure, fistula, condyloma acuminata, and full-thickness rectal prolapse). Prospectively accrued subjects included attending physicians, fellows, residents, and medical students. Subjects were shown images and asked to provide a written diagnosis. We prospectively evaluated the overall diagnostic accuracy and stratified accuracy across specialties and years of clinical experience. Medical students were the control group.

Results: There were 198 physicians and 216 medical students. Overall diagnostic accuracy for physicians was 53.5% and for controls was 21.9% (P < .001). Surgeons had the highest overall accuracy at 70.4%, whereas all of the other groups had an accuracy of <50%. Physicians correctly identified condylomata and rectal prolapse most frequently and hemorrhoidal conditions least frequently. All 7 conditions were correctly identified by 4.1% of subjects and all of the conditions were incorrectly diagnosed by 20.2%. There was no correlation between years of experience and diagnostic accuracy (P = NS).

Conclusion: Diagnostic accuracy for common benign anal pathologic conditions was suboptimal across all clinical specialties. Although many specialties had a diagnostic accuracy that was significantly better than the control group, there was no association between years of experience and accuracy. Improved programs for physician education for these common conditions should be developed.