Thread by @medrants

1/ Multiple diagnostic errors

Recently at morning report #UncleBob & @uabimres discussed a sad patient story w/ a bad outcome. Pt was ill for 3 months. Multiple chances for a proper diagnosis were missed. @LindseyShipley8 @SZKamal @ImproveDX @CPSolvers

2/ Cognitive autopsy

After working through the discussion, I asked the residents to take less than #5goodminutes to write down the reasons for the delayed diagnosis. Here are some of the clues that were missed prior to transfer to our hospital:

3/ Missed opportunities

Diagnostic inertia
Several clues in laboratory testing
Incomplete history taking
Incorrect image interpretation
Physical exam of obvious weight loss ignored
Over-reliance on a positive lab test that did not match the problem representation

4/ Diagnostic time out

Too often busy physicians do not take diagnostic time outs. We all understand the time stress of patient care. Nonetheless, we owe our patients the awareness that sometimes patients deserve extra time. Perhaps this post is overly critical.

5/ The importance of diagnostic errors

We owe our patients the best possible efforts at making the proper diagnosis. Treating the patient and not getting results should trigger these diagnostic time outs. Continue doing the same thing and expecting a different outcome ...