Commonest error in medicine?

Robert M Centor rcentor at UAB.EDU
Tue Nov 25 13:47:44 UTC 2014


In my clinical experience as an academic hospitalist, the label of community acquired pneumonia leads most often to diagnostic delay.  It has become a “waste basket” diagnosis from many emergency departments and for many admitting physicians.

--
Robert M Centor, MD, MACP

Chair ACP Board of Regents
Regional Dean, UAB Huntsville Regional Medical Campus
301 Governors Drive
Huntsville, AL 35801

Office: 256-539-7757
Fax: 256-551-4451

Professor, General Internal Medicine
UAB
FOT 720
1530 3rd Ave S
Birmingham, AL 35294-3407
Office: 205-934-3007

From: darryl mackender <dmack2795 at GMAIL.COM<mailto:dmack2795 at GMAIL.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, darryl mackender <dmack2795 at GMAIL.COM<mailto:dmack2795 at GMAIL.COM>>
Date: Monday, November 24, 2014 at 10:34 PM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Commonest error in medicine?

Robert & Bill & others
PTE is certainly commonly misdiagnosed, & undoubtedly often over diagnosed but is also a common dual diagnosis (The Ockhams Razor error) but I suspect in non-Cancer ambulatory general medical inpatient admissions the incorrect diagnosis of sepsis as CAP or urosepsis without much corroborating evidence is more common as both over & under diagnosis & probably of greater quantum of consequence - sepsis or suspected system specific infection ( CAP, gastroenteritis, urosepsis, septic arthritis, cellulitis, meningitis) needs to be seen as a syndrome can diagnosis with major & minor criteria & a diagnosis as probable, or suspected or confirmed ala Rheum Dx.
There is ample data on these broad areas to consolidate a core set of major & minor criteria for suspected sepsis that applies to each organ set.
We could then develop a pathway approach much as suspected Acute Coronary syndromes have been managed to deal with undifferentiated chest pain. We may not have a troppo in equivalent for many organ sets but a proxy which is as close to a troponin-like criteria can be developed for each organ set.

It needs to be generalisable & emphasise evidence based history taking & evidence based physical signs before complex investigations unless they are as easy to use as troponin & quantifiable D-dimer.

Darryl Mackender
Director Physician Training Orange NSW


On Tuesday, November 25, 2014, Slater, William <WSlater at phcn.vic.gov.au<mailto:WSlater at phcn.vic.gov.au>> wrote:
Ok, Robert. I like this.

Are you suggesting that PE is no 1 miss-diagnosis or perhaps over-diagnosis?
Or are CTPAs (with the radiation exposure) done far too often because the d-dimer test is misused or misinterpreted??

In my view we may be over-diagnosing and therefore over-treating small, clinically insignificant PEs.


Bill Slater FRACP

Director Physician Education Peninsula Health Melbourne

From: robert bell [mailto:rmsbell at ESEDONA.NET<javascript:_e(%7B%7D,'cvml','rmsbell at ESEDONA.NET');>]
Sent: Tuesday, 25 November 2014 11:41 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG');>
Subject: [IMPROVEDX] Commonest error in medicine?

A thought.

Do we know what is the most common serious error in diagnosis in medicine in the USA?

If not can we guess at what is the commonest error in diagnosis? And then perhaps the top five.

Then could we discuss intensely on line and come to conclusions as to how we could lower that rate?

When we have come up with a list of suggestions for that one error we move on to Number 2  on what we think is the list of commonest serious errors in Medicine and how to reduce their incidence.

This way we would be doing something positive rather than just talking. Not that talking is important.

My contribution for serious No. 1 is Pulmonary embolism.

This way we could just on line make a seripous contribution to medicine particularly if someone would write up our discussions.

A thought


Robert M. Bell, M.D., Ph.C.



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