Trending issues in medicine 2015 – #5 Diagnostic accuracy

As the year ends, we have a responsibility to survey the medical landscape and identify the major issues that are impacting physicians and therefore patients.  I have chosen 5 topics to discuss.  Today I will focus on one that I have addressed often over the past decade – diagnostic accuracy. Today’s NEJM has an article that, in my opinion, misses the point –Reducing Diagnostic Errors — Why Now?  As most readers know, the Institute of Medicine has published their opus on the topic –Improving Diagnosis in Health Care Here is my take.  As we practice medicine and teach medicine we have time limitations.  Diagnosis has not held central importance in the minds of the insurers and regulators.  Three trends have dominated practice, and thus left less time for diagnostic thinking.  First, our payment systems that Medicare leads.  Our payment systems drive us to see too many patients during each day, thus shortening each visit.  While we can do a great job with some patients in limited time, diagnostic dilemmas take much more time.  But where do we get that time?  Who pays for us to read, ponder and discuss our complex diagnostic concerns? Second, the ill-constructed performance measures assume that we always have the proper diagnosis.  I have seen patients perfectly treated for their “congestive heart failure”, giving their primary care physician a perfect scorecard, but the patient really had COPD, OSA and right sided heart failure...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs