A study entitled ‘The Ecology of Medical Care Revisited’ from the NEJM of June 2001 graphically shows how important it is to try and guide and influence the patient from a very early stage in order to ensure appropriate flows into primary and secondary care. Encouraging patients to use a symptom checker could be one way to help them at that crucial stage when they are considering seeking care.

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: