When in medical practice we speak about “Diagnosis” we think about the exact moment where the problem in a patient is detected. But it,s not only this, a whole process needs to be implemented to reach a correct answer. But, why diagnosis? And why is not seen like an important step to change medical practice?
First question: How important is a correct diagnosis?
1. The prevalence of Diagnostic error (DE) is difficult to measure and is very “site” dependent. In several studies related to patient safety, around 5-15% of adverse events are diagnostic errors.
2. Diagnostic errors occupies the first place for legal claim in several medical insurances companies in United States.
3. Diagnostic errors are difficult to measure because the harm associated to them is not always detected. We only see the “iceberg” peak.
4. The most important aspect is that DE are the origin of important physical and emotional disturbances for the patient and the family.
Second question: Why they don,t get the respect that they deserve?
1.Clinical practice is still seen like a perfect world where a mistake is related with a bad professional.
2. Doctors around the world are “under protected” for situations like DE. In comparison with the airline world where accidents are relatively accepted, Medicine is considered an exact science. In some countries the government play the perfect role and practitioners are treated like “robotic” workers.
3. Clinical practice needs to incorporate a “second circuit” of learning and improving, based on clinical problems detected on the everyday life.
But perhaps the most important consideration is the Diagnosis Improvement goal is a real path to start a change in Medicine.
A complete “corpus” of teaching material has been published, basically under the umbrella of the Society to Improve Diagnosis in Medicine (www.improvediagnosis.org)