Role of diagnosis in cutting waste in clinical care

Ehud Zamir ezamir at UNIMELB.EDU.AU
Fri Nov 7 11:33:19 UTC 2014

"The key question is how do you (practically) make our current clinicians "skilled diagnosticians" (those that aren't already of course)?"

I will try to suggest a practical answer: I am not sure you can make our current clinicians "skilled diagnosticians". However, you can invest in your next generation of diagnosticians. The elephant in this room, in my view, is that not everyone CAN be a skilled diagnostician, just like not everyone can be a competent surgeon or an airline pilot. It seems to me that we regard the issue of insufficient diagnostic ability as a taboo and hardly mention it.  We will only be able to improve if we are willing to acknowledge that not everyone who has high enough high school marks to get into medical school at 18 has the capacity to eventually become a good diagnostician at twice that age.

So there should be three parts to this: increased emphasis on diagnostics during training, better assessments, looking at realistic, authentic diagnostic performance as opposed to contrived exam performance, and finally openness to the idea that not everyone who starts medical school should eventually be allowed to practice as a specialist/ independent medical practitioner. I suspect investing in education and more rigorous assessments during speciality training will be far more beneficial and practical than  re training doctors who despite many years of experience lack expertise. If we start doing it now, then in 20 years the mix of diagnostic skills will probably be significantly more favourable than it is now. I think Jerome Groopman put it much more eloquently in his book "How Doctors Think".

There is, of course, a political problem here, as those who make decisions about education first need to acknowledge that the current system of medical education and assessment is not optimal. Given that medical education is increasingly being hijacked by "educationalists" who often are non medical education academics with little or no medical knowledge, I doubt they will drive such a change or agree to it. Similarly, medical associations will likely object to a "we deserve better doctors" move.


Ehud Zamir, MD, FRANZCO

Clinical Senior Lecturer
The University of Melbourne
Centre for Eye Research Australia
The Royal Victorian Eye and Ear Hospital
32 Gisborne Street
East Melbourne, Victoria 3002

From: Jason Maude [Jason.Maude at ISABELHEALTHCARE.COM]
Sent: Friday, 7 November 2014 4:21 AM
Subject: [IMPROVEDX] Role of diagnosis in cutting waste in clinical care

You may all be interested to see a paper just published by the Academy of Medical Royal Colleges in the UK entitled "Protecting resources, promoting value:

a doctor’s guide to cutting waste in clinical care"

My favourite part is on P20 where it states so perfectly:

"Fundamental attributes of a value-promoting doctor

A skilled diagnostician:

forms intelligent differential diagnoses and can discern which investigations are truly necessary to diagnose and treat the patient effectively."

The key question is how do you (practically) make our current clinicians "skilled diagnosticians" (those that aren't already of course)?


Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890<>


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