Discontinuity of Care as a Cause of Dx Error

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Thu May 16 21:44:50 UTC 2013

As always, the single variable that is part of that ever-changing dynamic
is the patient himself.  That goes to the patient/family understanding that
something is amiss, that "this" is out of the norm.  The patient is naively
assuming that the doctors et al speak to one another, and that they share
the info, including that given by the patient.

To assume that there is communication between the specialist and the family
physician, and that both parties have equal access to the other data is
also naive.  Moreover, there is usually no motivation on the part of the
family doctor to intervene, as the reason that the patient is seeing the
specialist is due to the limitations of the family doctor. The real
question here is whether the proper specialist has been recommended.  We
patients ask if we need a pre-emptive diagnosis to find the proper

How hard is it to have the doctors ask, "What do think is happening here?"
to the patients, and to LISTEN to the answers.  We patients have to
understand that unless we are true partners in the decision-making, and
educated to the maximum extent possible to do that, we will continue to be
acted upon by providers, not truly cared for by those providers.

Peggy Zuckerman

On Thu, May 16, 2013 at 1:49 PM, Graber, Mark <Mark.Graber at va.gov> wrote:

> 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.
> Mark
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
> for Improving Diagnosis in Medicine
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Peggy Zuckerman

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