Graber, Mark Mark.Graber at VA.GOV
Sat Apr 26 18:00:57 UTC 2014

I'd like to underline the comment from David Gordon that .... "Ultimately, this evolving science about how to improve diagnostic efficacy is going to have to balance the harm that can come by both under and over diagnosis".  I couldn't agree more.

David was concerned that if we see an 'explosion' of research that focuses excessively on delayed and missed diagnoses, we will under-emphasize the harm from over-diagnosis.  I certainly acknowledge the costs and harm from over-diagnosis, but would argue that an explosion of studies on diagnostic error (under-diagnosis) is exactly what's needed right now to understand how to improve the efficiency and quality of diagnosis.

If there is going to be any explosion (doubtful, given that the funding for dx error research is almost nil at the moment) my bet will be that this will come from the over-diagnosis community.  The evidence for this is number of abstracts submitted to the Overdiagnosis Conference (in the hundreds) vs the Diagnostic Error in Medicine conference (a few dozen).  And the reason is that it is so much easier to study over-diagnosis - all the data has already been collected, and the extra CT's and incidentaloma's have all been tallied.  Finding and studying under-diagnosis is much harder, for all the reasons everyone has described.  It may take months or years to know that a diagnosis was missed and in many cases we may never know at all.

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