Ideas on improving rates of missed/delayed diagnoses in PCP type visits.

Kuhn, Gloria gkuhn at MED.WAYNE.EDU
Mon Jan 20 15:59:24 UTC 2014

I would and have.  One example:  Patient came in stating she had one cause of a rash.  We did a work up to make sure it was not something else but I told her and her sister I would call with the test results.  If they were negative she had made the diagnosis by looking on the internet which was fine.  If she was not we would treat the actual cause of the rash.
From: Vic Nicholls [nichollsvi2 at GMAIL.COM]
Sent: Monday, January 20, 2014 9:52 AM
Subject: Re: [IMPROVEDX] Ideas on improving rates of missed/delayed diagnoses in PCP type visits.

This was another great post John.

Here is a question for doctors: if someone comes in and says I have
symptoms X, Y, and Z, and think I have diagnosis A, would the clinician
be open to think about the criteria for the diagnosis and say, it is
possible but have you explored diagnosis B or C? That would also fit
your symptoms. Lets see what other symptoms you have to narrow it down.

This would help in having confidence in the doctor, less reliance on
Oprah type diagnoses, and doesn't appear to take a lot of time.

What about something like that? Question for the professionals on here.


On 1/19/2014 10:19 PM, John Brush wrote:
>       I think that the emphasis on “patient-centeredness” has largely focused on therapeutic decisions, and hasn’t adequately addressed diagnostic decision making. There needs to be more engagement. There are problems on both sides of the conversation. Many patients seem to seek the illusion of certainty. Some are biased by dread or wishful thinking. It is hard to be objective when you are the patient. All doctors are patients at some point, and know that they aren’t very good at diagnosing themselves.
>       I think it is a good idea to inform patients about the inherent uncertainty in diagnosis. I often ask patients “what do you think it is?” Sometimes I get a helpful answer. But usually, it least the question serves to get the patient thinking about the imprecision of testing and the difficulty in establishing a firm diagnosis.
>       I think there is one other lurking problem. The malpractice environment has a priming effect that can cause doctors to view patients and their families as potential litigants. Doctors can get defensive when patients ask questions about the diagnosis. Doctors need to recognize that this is usually irrational and they need to work on getting past that priming effect. Also, unfortunately, doctors visits are often too time-pressured to have a decent in-depth conversation.
>       There are a lot of barriers that inhibit getting patients better involved. It would be good to discuss the barriers and bring these impediments to doctor’s attention. I think the vast majority of doctors would like to learn how to better engage patients in diagnostic reasoning. I think helpful feedback and suggestions would be welcomed by virtually all physicians.
> John

Moderator: Lorri Zipperer Lorri at, Communication co-chair, Society for Improving Diagnosis in Medicine

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