motivations for the right dx

Karen Cosby kcosby40 at GMAIL.COM
Wed Jan 22 16:11:31 UTC 2014

I'd like to think most doctors always want to be right for many reasons.
 First, the ability to make the right diagnosis goes to the heart of their
professional skills.  Secondly, doctors need to be confident because they
have to trust their skills in moments when their decisions can impact life
and death.  I don't think most doctors need any more incentive than that!
 However, perhaps more importantly, they need freedom from disincentives.
 Increasingly doctors are pushed by limits on times, and limits of testing.
 I know my productivity is being watched and measured, and my
administration isn't shy to embarrass or punish me for not seeing enough
patient's per hour or ordering too many tests.  Many groups offer bonuses
based on productivity. However, I have never known anyone to be rewarded
for a "good save" or "timely diagnosis" beyond their own personal
satisfaction (which is more than enough!).

On Tue, Jan 21, 2014 at 6:56 PM, Vic Nicholls <nichollsvi2 at> wrote:

> Something I don't think we've kicked around:
> what would influence doctors to go a little further for the right dx? I
> have a lot of comments from the doctors side, but is it money that entices
> or a pat on the back? I tried pats on teh back with some other doctors and
> it backfired.
> What happens with a complex/complicated patient?
> On 1/21/2014 12:36 PM, Graber, Mark wrote:
>> This is an important comment, and thanks Victoria for both sending the
>> note to your physician and mentioning it on this forum.  In an ideal world,
>> care would be both patient centered AND knowledge-based.  These goals come
>> into conflict a lot these days - many physicians don't take the time to
>> take advantage of decision support resources, and some believe that their
>> patients will perceive them negatively for doing so.
>> Hopefully someday we will get to the point that physicians use decision
>> support routinely, and patients see the value in this, as you did.  The
>> trick is to somehow maintain the patient-centered focus, and not spend so
>> much time at the keyboard that the patient feels neglected.
> Moderator: Lorri Zipperer Lorri at, Communication co-chair, Society
> for Improving Diagnosis in Medicine
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