An Institute of Medicine (IoM) study predicts that most people will experience at least one wrong or delayed diagnosis over their lifetime.
Are you surprised?
Yep, I wasn’t either.
This is yet another IoM report that essentially says that medicine continues to be more of an art than it is a science. And it is no wonder. With all of the variables influencing the health of an individual person, combined with our relative lack of knowledge about how the body exactly works, it’s actually surprising to me just how low the diagnosis error rate is.
Of course, the diagnosis error rate is probably underreported, as the study points out – not because of malice but simply oversight.
If we dig deeper the report findings have real implications for prehospital providers. Medics tend to operate in the diagnostic mode – perform an assessment, take a patient history, apply their knowledge of anatomy, physiology and pathophysiology, and come up with a field impression – working diagnosis – and apply a treatment plan based on that presumption.
Our challenge is that we perform the task of patient diagnosis with relatively limited knowledge and minimal diagnostic testing. It is presumptuous of us to believe we can definitively define what the patient is experiencing in the field, yet we are pressed to make one.
I suspect most of us are pretty comfortable allowing patients to refuse medical treatment and/or transport to an emergency department. Most of us will tend to err on the side of the patient’s care, carefully explaining the circumstances of the refusal, the consequences of refusing additional treatment and transport, and getting an explicit response from the patient that he fully understands the risks associated with such a decision. But many of us might allow a patient to refuse – or in reality, we refuse the patient – because we have diagnosed that the patient’s complaint is so trivial that it doesn’t merit further evaluation. That’s when things get dangerous and doesn’t serve the patient’s best interest.
The takeaway message is this – always consider alternative diagnoses. Keep your clinical mind open to other possibilities, allowing yourself to maintain a certain level of objectiveness and avoid a severe case of tunnel vision.
