Setting the record straight on measuring diagnostic errors. Reply to:'Bad assumptions on primary care diagnostic errors' by Dr Richard Young

H Singh, DF Sittig - BMJ quality & safety, 2015 - qualitysafety.bmj.com
BMJ quality & safety, 2015qualitysafety.bmj.com
This means that the few times over the course of my career that I care for a patient with the
first manifestations of a rare disease, I should not be vilified for making a delayed diagnosis.
I will figure out the rare disease a few weeks or months later when the cough persists
beyond that of a common condition, or when a true red flag sign or symptom appears. Every
element of the history, review of systems, family history, social history, examination and other
factual nuggets speaks to the probabilities of the rare disease (or unusual presentation of a …
This means that the few times over the course of my career that I care for a patient with the first manifestations of a rare disease, I should not be vilified for making a delayed diagnosis. I will figure out the rare disease a few weeks or months later when the cough persists beyond that of a common condition, or when a true red flag sign or symptom appears. Every element of the history, review of systems, family history, social history, examination and other factual nuggets speaks to the probabilities of the rare disease (or unusual presentation of a more common disease), but the chance of complete reassurance of a benign condition or harbinger of a severe disease at the initial presentation never comes close to certainty. Instead of vilifying me, the regulators and other pundits should congratulate me for keeping from harm the thousands of patients with coughs I did not expose to unnecessary fear, expense and radiation.
Family physicians and general practitioners deliver better care at a lower cost than all other physicians precisely because we are more comfortable with uncertainty and are comfortable applying overall probabilities to individual patient care situations. Except in the most straightforward cases of blatant negligence, the language of delayed or missed diagnoses has no place in our world.
qualitysafety.bmj.com