Discontinuity of Care as a Cause of Dx Error

Graber, Mark Mark.Graber at VA.GOV
Thu May 16 20:49:45 UTC 2013

Diagnostic error is making news these days, stimulated by the recent publications by David-Newman Toker and colleagues on malpractice claims and Hardeep Singh's work on the frequency of diagnostic error in primary care.

CBS This Morning featured a story <http://www.cbsnews.com/8301-33816_162-57584037/medical-misdiagnosis-how-to-protect-yourself> by their medical news reporter Holly Phillips that focused on not having a family physician as 'one of the major reasons'.  I'm not sure how she picked that particular angle out of the hundreds of system-related root factors that contribute, but I think she's right.  There is certainly data that shows our brains are adapted to perceive a CHANGE faster and more accurately than if the same abnormality is part of a static picture, and it seems to me related phenomena explains why we miss key diagnostic clues that are so obvious to the patient's family, as well as the diagnostic errors she's thinking about in her story relating to discontinuity in care.  I'm worried this also plays out as an unintended consequence of work-hour limitations in our hospitals - the physician doing the admission work-up will be replaced by someone else that night when your condition deteriorates.


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