Fwd: [IMPROVEDX] IOM report is released - Diagnosis in actual practice

Mark Graber mark.graber at IMPROVEDIAGNOSIS.ORG
Fri Oct 2 18:45:36 UTC 2015

Note and manuscript forwarded on behalf of Dr Bimal Jain.
From: Jain, Bimal P.,M.D. 
Sent: Thursday, October 01, 2015 1:54 PM
To: 'Mark Graber'
Subject: RE: [IMPROVEDX] IOM report is released - Diagnosis in actual practice
Hi Mark and all,
It is important to understand how diagnosis is performed in actual practice as a correct diagnosis is made after all  85 percent of the time in practice. To reduce diagnostic errors, we need to know if the method in practice needs to be improved or whether certain deviations from it need to be eliminated. The most puzzling issue in this regard is the role that probability plays or does not play in diagnosis. The puzzle arises because a probabilistic approach has been prescribed for a long time, but it does not appear to be employed in practice when we look at published CPCs and clinical problem solving exercises. Does this disparity imply that a probabilistic approach is not suitable for diagnosis in actual practice? This is certainly possible as diagnosis is performed in a given, individual patient with the aim of determining a disease correctly in that particular patient. And probability, as is well known has been employed most successfully in practice in areas such as epidemiology and life insurance business where the focus is on accuracy of prediction in a large group of persons, not on prediction in a given individual person.
If we look closely, we note that a strict probabilistic approach in which a probability represents evidence may actually increase diagnostic errors specially in patients with atypical presentations by encouraging the cognitive bias of representativeness and inhibiting comprehensive differential diagnosis (discussed in attached paper).
I have put together my thoughts on this subject in the attached paper ‘The role of probability in diagnosis’. Please review and comment on it. Thanks.
Bimal P Jain MD
Pumonary-Critical Care
North shore Medical CENTER
Lynn MA 01904

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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