Blog | Friday, December 7, 2012

Why diagnosis is job 1


As a high school student I remember hearing the phrase "great diagnostician." Today we rarely hear that phrase. We do not often hear the wonks and politicians invoke diagnostic accuracy. Many speeches champion quality care, but then they define quality on the basis of performance measures.

Sitting in the audience at the 5th diagnostic errors medicine meeting, the thought becomes clear that we generally undervalue the importance of correct diagnosis. Our payment system discourages the most important variable in diagnostic accuracy, adequate time to think, take a careful history and do a competent physical examination.

Since we believe that diagnosis is really job 1, we must understand that great diagnosticians require multiple tools. First, they must have the time and skill to take a careful and complete history. Second, they must do a careful targeted physical examination. Third, they should order and interpret diagnostic tests. Fourth, they must do the same with imaging and other studies. Finally, they must have the experience and knowledge to combine all those data to arrive at correct diagnoses. Oh, and they must have enough time to do all these things.

It really is complex. We must champion fixing a broken system for the sake of accurate timely diagnosis. Then, and only then, can we worry about treatment.

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.