Recently I heard about a patient who had a diagnosis missed by a subspecialist and a surgeon. The correct diagnosis required surgery, yet two excellent physicians elected against surgery until further evidence pushed them to surgery the following day.
They both unfortunately fit the detective that Sherlock criticized:
"You have a solution that you like, but you are choosing ignore anything that you see that doesn't comply with it."
--The Blind Banker, Sherlock Season 1 Episode 2
Recent readers may know where I am going. The affect heuristic infected these physicians. They liked an alternative diagnosis. They liked their diagnosis so much that they "explained away" a conflicting clue.
Please do not think poorly of these physicians; they are humans reacting to situations in human terms. But please learn from this and similar diagnostic errors. We must keep our minds open and not jump to a diagnosis.
Diagnostic errors are the major quality concern that we do not measure. Diagnostic errors unfortunately are rampant, but too often ignored when the quality "gurus" discuss physician quality.
We have no measures for diagnostic accuracy, nonetheless it is critical:
"Not everything that can be counted counts, and not everything that counts can be counted."
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.