Why diagnosis is job 1

5

Category : Medical Rants

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.

Comments (5)

Internists used to be called diagnosticians.
20 years ago, phone book yellow pages had listings for "diagnosticians" among all the physician specialties.
 
-Steve

One more thing if you may want to add to your list – empirical therapy has limits and those need to be understood; too often, patients are treated empirically for too long – the empirical therapy hurts the patient and the diagnosis in the long run.

Other professionals are paid for their time, eg Accountants, Lawyers. Does it not make sense to pay Physicians for their time as well, instead of CPT codes? Why is this even an issue?

so what do you do when you're the patient and tough to diagnose?  i've got an autoimmune disease that makes any diagnosis difficult, and frankly, my internist has been wrong about every diagnosis he has ever given me.  i hate to change doctors, as i've invested over a year in him, and personally, he seems like a nice guy, but he's a terrible diagnostician.  any ideas on how to get him to think outside of the box without offending him?

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