Diagnosis is the neglected stepchild in today’s healthcare system. The big money, or low hanging fruit from a financial viewpoint, is found in chronic disease management and perhaps (but not definitively) in cancer screening. But in the stories of people’s lives, errors in diagnosis seem more tragic, because those situations involve a patient who is actively seeking medical help. If people choose not to have their pneumonia shot or lung cancer screening, they presumably weighed the pros and cons of those interventions and were willing to take the consequences of their decisions.
In my Swedish medical training, we were told that no doctor can be right 100% of the time and we needed to understand that. There is no comparison between the Swedish no-fault compensation for patients who have been hurt or misdiagnosed and the American malpractice quagmire. If a Swedish doctor makes an error in judgment there may be disciplinary action, but no financial penalty. To a greater degree than in the United States, doing what a reasonable clinician would do in the same situation will usually protect you from disciplinary action.
Does this difference make Swedish doctors miss more diagnoses than American doctors? I don’t think so, but I don’t know if there are studies about that.
The AI answer to my Google search “margin of error in medical diagnosis” looks like this:
A 10-30% error rate seems like a frightening number to me. But I do worry that chronic disease management is such a strong focus in today’s healthcare that diagnostic skills have become a bit marginalized. And this is not just a matter of shorter and sloppier physical exams today, but also an issue with less time and less practice in taking medical histories. This is in part due to the mandated screening questions we have to ask about everything from domestic abuse to depression - all worthwhile, but when a patient has a new symptom or a new concern, maybe we need more flexibility in how many minutes we should spend on what they actually came to see us for.
As a family physician going through residency in the 1980s, I was trained to deliver babies and had the option to qualify for doing Caesarean deliveries, colonoscopies and many other procedures. I also took care of people in the hospital, including the intensive care unit. I don’t do any of those things now, just like many of today’s family docs. Instead, there is growing specialization within family medicine, such as added certification in geriatrics or sports medicine.
Maybe we should consider “Diagnostician” as a carve-out, especially if we work in medical groups with new medical graduates, Physician Assistants and Nurse Practitioners. In some cases, with more experience under our belt, we may make a diagnosis quicker than our colleagues with less training and experience and in some cases, having diagnostic days when we are excused from health maintenance and chronic disease management, we could dig deeper for the correct diagnosis in difficult cases?
Really good to hear how physicians are treated in other countries. So sad that our dysfunctional healthcare system ignores the much lower maternal mortality rates in other countries as well as treating physicians with the respect they deserve even if they make a mistake. I'm so tired of the government weaponization of healthcare oversight.
Well said Dr. Duvefelt.