Discontinuity of Care as a Cause of Dx Error

Wansaicheong Gervais Khin-Lin (TTSH) gervais_wansaicheong at TTSH.COM.SG
Fri May 17 01:24:43 UTC 2013


The problems with figuring out what causes misdiagnosis are probably the same as the reasons for misdiagnosis.
We like to simplify where the problem is sometimes too complex to simplify.
Just having a family physician is not going to help if the family physician does not review results or gets swamped with data.
A true cognitive gap (lack of knowledge) will not overcome a caring nature, no matter how reassuring to the doctor or patient.
Fatigue limits mental and physical ability.
Increasing work-hour limits (either because of prior abuse or doctor as hero complex) only makes the problem worse.
Like some of the participants have raised, consider asking about the other differentials before proposing a solution.
It would be ironic if the causes if misdiagnoses are themselves misdiagnosed.

Gervais

-----Original Message-----
From: Graber, Mark [mailto:Mark.Graber at VA.GOV]
Sent: Friday, May 17, 2013 4:50 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Discontinuity of Care as a Cause of Dx Error

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


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