The Wall Street Journal ran a special report on healthcare this week and included two great articles that both referred to the Isabel diagnosis decision support tool:
Isabel Healthcare Blog
The Isabel project was inspired after my own daughter’s near fatal misdiagnosis in 1999. Last week I experienced my own misdiagnosis. Although far less serious, the episode is probably as instructive for the lessons it teaches. It showed me how easy it is to happen, how it’s often nothing to do with lack of time but just down to sloppy thinking. The discipline of doing a differential diagnosis (even for what seems a blindingly obvious, straightforward diagnosis) is crucial to avoid the sloppy thinking traps.
Over 45 years ago, in 1968 Dr Lawrence Weed published an article on Medical Records that Guide and Teach which described the problem-orientated medical record (POMR) where organized problem lists and medical records are critical to clear decision making. The POMR was implemented worldwide and became a standard for medical documentation.
A landmark article published yesterday in “JAMA Internal Medicine” entitled “Types and Origins of Diagnostic Errors in Primary Care Settings” once again highlights the importance and value of traditional clinical skills and the differential diagnosis.
The study looked at 190 cases of diagnostic error highlighted by triggers within the medical record such as unexpected return visits etc. rather than malpractice suits. The settings were two large sites each with a list size of around 50,000 patients-one was public health (Veterans Administration) and the other an integrated private healthcare system. The key points from the paper for us were: