Would you agree that faulty diagnosis can occur when patients 'request' it or clinician has a diagnostic fade? Eg Coeliac disease
Yes, this can potentially occur. Clinicians can be distracted when the patient presents with a certain diagnosis in their mind. "Dr Google" may be a factor in such cases. It is necessary to ensure you take an appropriate history and listen to the patient about their concerns. There should be an examination and any relevant investigations for you to form a differential diagnosis, based on the specific circumstances of the individual patient. However, clinicians should stay focussed on what would be considered normal practice by their peers.
We used to have a local audit system for hospital errors, but the funding for it dies. Any ideas for persuading them to start up again?
Any review of morbidity, mortality or near misses is a fundamental quality control measure for patient safety and should be encouraged, and indeed in some cases are required. Sadly, funding in healthcare can be problematic - there is no easy answer to this question.
If an incorrect diagnosis is made initially, how important do you believe "anchoring" is in delaying correct diagnosis & treatment?
Anchoring bias - locking on to a diagnosis too early and failing to adjust to new information, has been shown in various studies to be a factor in diagnostic error. Members should always be open to any new or different information and the results of further investigations to ensure a thorough ongoing evidence based diagnosis.
If I forget to ask a woman of reproductive age and send her for a chest x-ray, what are the consequences for that? Do I need to do a pregnancy test for a woman of reproductive age before send for imaging study?
The benefits of an investigation need to outweigh the possible harm. With a pregnant woman, this may require extra care. All women of reproductive age who are sent for z-rays need to be assessed for pregnancy. The clinician should establish that pregnancy is not possible and preferably document the reasons. This may include doing a pregnancy test but this is not always indicated. There will be situations where an x-ray of a pregnant woman is still indicated however, this would require careful explanation of the risks.
What is your view about fear of missing diagnosis resulting in over investigating or resulting in unneccessary investigations, and do you think the following clinical guideline will minimize clinical error? Recent case: "sue if you do, sue if you don't" is interesting.
The reality is that it is rare for medical practitioners to be sued in Australia. Various hurdles have to be met first, such as permanent disability thresholds, in order to bring a common-law claim. Most litigation is compromised outside court. The level of care including investigations should not be determined by such concerns of litigation or complaint. A reasonable evidence based approach which would be accepted by your peers should be adopted.
How about if you ask the patient to come and see us again and they ignore, how many attempts should we do before exhaust our system? I mean if something happens, will Dr be responsible or the patient?>
It depends on the seriousness or potential consequences of the illness or disease. The best protection you can have is to carefully document all unsuccessful attempts to contact the patient and to send a registered letter to their last known address (and maintain receipt of that communication).
Do you find that there is an increasing culture and awareness directed to diagnostic errors in medicine in physicians and other allied health professionals?
Yes, this is slowly emerging and is such an important and fundamental component of medicine.