Philip Levitt, M.D. - Company Message
My Blog

The avoidance of missed diagnoses

The last time I posted I wrote about the frequency and danger of diagnostic errors. How do we make them less frequent? The information on how to do that is sparse and definitive solutions are lacking. However, several groups of doctors are involved in active quests for answers. To see what they are up against,  let us look at how doctors first learn to make diagnoses.

After gorging their brains with anatomy, physiology, pathology and biochemistry for months on end, medical students are finally allowed onto a hospital ward to examine their very first patient.  This can be a scary event for many of them and for which they have taken many days of preparation. The first and diagnostically most important part of the exam is the history -- the story the patient tells. This must be obtained with as little prodding as necessary so as to not "lead the witness". "I noticed this lump in my breast", "I began to vomit up blood" ,"I noticed that my eyes and skin had turned yellow" and "I had the worst headache of my life all of a sudden" are typical  worrying chief complaints.

Beginning with the patient's chief complaint, the doctor must listen creatively, make up hypotheses about what is going on  and think of multiple diagnoses based on what the patient is saying and ask questions which separate one possible diagnosis from another. A doctor must be ready to ask the patient those questions that can either seal a diagnosis on the one hand or force him or her to consider a whole spectrum of disorders that can produce identical symptoms on the other. Making up a rolling list of possibilities as one draws out the patient's story is a purely mental process.  This takes time, patience, skill, knowledge and experience to perfect. The physical exam that follows usually confirms what the doctor suspected from taking the history. At other times, however, it can yield a key finding not suggested by interviewing the patient.   

With the history and physical completed, the doctor, neophyte or veteran, must put everything found at the bedside together and state formally in writing a differential diagnosis, a reasonable list of possible ailments to explain the findings. This always seemed obligatory to me until I read an excellent paper from the University of Iowa about missed diagnoses by veteran primary physicians. With the benefit of hindsight, the majority of the doctors who missed diagnoses admitted that they had failed to make up an adequate differential diagnosis. As many clinicians do in their busy practices, they had used a common method in which they had stopped thinking after arriving at the diagnosis that came most forcefully to mind. Old hands in medicine are accurate with this approach quite often because they have seen so much. The name for it is "pattern recognition".    Pattern recognition  takes less time than formulating and writing out a differential diagnosis. It is not an entirely bad way to diagnose disease and it must suffice in dire emergencies where there is no time to lose. 

Scientists who study how best to reach the correct diagnosis have found that when the two processes, formulating a differential diagnosis and  pattern recognition are combined, the rate of getting the correct diagnosis is better than when either is used alone. Another way of avoiding missing a diagnosis is repeating the examination at a later date if time permits and getting a colleague to do a consultation to check if something was missed or not thought of. There is no shame in either approach and I have seen the best doctors of my acquaintance get help with puzzling cases. 

Researchers in the field of diagnostic errors do not put much faith in check lists or computer programs designed to make diagnoses. They feel that the field is wide open and must be rethought. We are dealing with the intellectual functioning of experts on the highest plane of their proficiency so that the going may well be arduous and slow in finding the solutions.

10 Comments to The avoidance of missed diagnoses:

Comments RSS
professional proofreader on Thursday, January 23, 2014 5:36 PM
Education development is necessary for every nation to keep their next generation according to world latest trends. Writers should play important role to awake nation.
Reply to comment on Sunday, April 20, 2014 11:34 PM
Rich in content, specific, every point is very good, is to this article, thank you. By the way, could you see our goods, you will like it.
Reply to comment

website on Wednesday, September 17, 2014 4:03 AM
Diagnostic errors to avoid it, things have to be careful.
Reply to comment

olymptrade on Monday, May 21, 2018 5:44 PM
Excellent article plus its information and I positively bookmark to this site because here I always get an amazing knowledge as I expect. Thanks for this to share with us
Reply to comment

i need an assignment on Monday, August 13, 2018 6:21 AM
I wonder what blog platform you use for this site. I'm sick and tired of Word press because I've had problems with hackers and I'm looking for options for another platform. It would be great if you could point me in the direction of a good platform.
Reply to comment

Tjia Wiwin Anggono on Sunday, January 13, 2019 11:13 PM
diri dan memenuhi permintaannya. Pengagum Chem berseini ke 13 pabrik astm a283 c pabrik pipa boiler pabrik plat abrex 400 pabrik plat asme516 grade70 pabrik plat astm516 70 pabrik plat boiler pabrik plat hb 400 pabrik plat high tensile sm490 yb pabrik plat high tensile sm490ya pabrik plat kapal Distributor besi Wf Baja undangan pernikahan bahasa inggris islam Distributor Besi H beam Toko Besi Beton Supplier pipa besi Toko Wiremesh Besi Toko Wiremesh Besi Pabrik wiremesh Distributor bondek undangan pernikahan amplop surat Distributor Besi Beton Jual Besi Beton Toko pipa besi Jual besi beton Sni Ulir Polos polos ulir Agen Wiremesh Besi Agen Wiremesh Besi Pabrik besi unp Distributor wiremesh undangan pernikahan unik dan murah Harga Besi Beton Agen pipa besi Jual besi beton sii Pabrik Wiremesh Besi Pabrik Wiremesh Besi Pabrik besi cnp Distributor pipa besi baja sch 40 sch 80 undangan pernikahan elegan Jual Welded Beam T beam King Queen Cross Castellated Beam Pabrik Besi Beton Pabrik pipa besi Jual besi beton psi Ulir Polos Distributor Atap Spandek Distributor Atap Spandek Pabrik besi hollow Distributor besi hollow undangan pernikahan animasi Jual Bondek Cor Distributor Besi Wf Baja Distributor sch 40 Jual besi beton perwira Harga Atap Spandek Harga Atap Spandek Pabrik besi beton Sni Ulir Polos Distributor besi beton Sni Ulir Polos undangan pernikahan lucu Jual Atap Spandek Sni Supplier Besi Wf Baja Harga sch 40 Jual besi beton PAS Jual Atap Spandek Jual Atap Spandek Distributor besi wf baja undangan pernikahan kalender Jual Plat Bordes Kembang Agen Besi Wf Baja Jual sch 40 Jual besi beton master steel ms Supplier Atap Spandek Supplier Atap Spandek Distributor stainless steel Distributor besi unp undangan pernikahan ala india Jual Plat Besi Hitam Toko Besi Wf Baja Supplier sch 40 Jual besi beton ksty
Reply to comment

CBD Tinctures on Thursday, March 14, 2019 7:26 AM
CBD and hemp oil online shopping. CBD and hemp oil products for sale online. Shop for CBD and hemp oil now!
Reply to comment

picbear on Friday, October 11, 2019 3:08 AM
Easily, the article is actually the best topic on this registry related issue. I fit in with your conclusions and will eagerly look forward to your next updates.Coming site picbear to watching mani nice video on instagram
Reply to comment

Lisa Taylor on Wednesday, November 13, 2019 4:52 AM
The most important thing is that this issue is not only actively discussed but also actively researched by doctors.Great blog design. I like to follow your creative ideas in blogging. If you are looking for high-quality text on any topic, we will help you at any time of the day quickly and efficiently. Keep delighting us with new posts!
Reply to comment

Ernest S. Hawk on Saturday, July 4, 2020 5:28 AM
Basic economics tells us how important receiving a quality education is for bettering ourselves and the future of our children. Education enables upward socioeconomic mobility and is key to escaping poverty. It is also essential for empowering people globally to live more healthy and sustainable lives CLIK HERE.
Reply to comment

Add a Comment

Your Name:
Email Address: (Required)
Make your text bigger, bold, italic and more with HTML tags. We'll show you how.
Post Comment


Recent Posts

Patient Safety Must Be Carefully Rethought
A New Hope for Reducing Medical Errors
Are Our Hospitals Getting Safer?
Lack of Insight
Errors in surgery are individual, not systemic


doctors' offices safety
hospital safety
military physician sacrifices
powered by