General Internists in Pursuit of Diagnostic Excellence

Excerpt

We thank Wallace and Matthias for their response to our call for diagnostic excellence in primary care.¹ In their letter, they point to limitations of likelihood ratios of symptoms and signs, giving the example of “cough, fever and auscultation” as being “insensitive and nonspecific for the diagnosis of pneumonia”. However, we believe this view downplays the relationship between inadequate data acquisition via history/exam and diagnostic error. Recent studies continue to support long-standing beliefs about the value of history and exam in diagnosis.² While we recognize the shortcomings of history or exam features, especially in isolation, several studies have found that inadequate histories and exams, as well as problems ordering subsequent tests based on gathered data, are frequently responsible for diagnostic errors.^{3, 4} In fact, clear red-flag symptoms/signs are often missed by clinicians, sometimes even when they exist in constellation.^{5, 6} …