"No-fault errors" - Understanding Diagnosis -2
"Once we realize that imperfect understanding is the human condition,there is no shame in being wrong, only in failing to correct our mistakes""
George Soros
Taxonomy of a Misdiagnosis;
Diagnostic error in medicine
could best be described using a taxonomy that includes no-fault, system-related, and cognitive factors.
No-fault errors
Masked or unusual presentation of disease
Patient-related error (uncooperative, deceptive)
System-related errors
Technical failure and equipment problems
Organizational flaws
Cognitive errors
Faulty knowledge
Faulty data gathering
Faulty synthesis
"No-fault errors" occur when the disease is silent, presents atypically, or mimics something more common. These errors will inevitably decline as medical science advances, new syndromes are identified, and diseases can be detected more accurately or at earlier stages. These errors can never be eradicated, unfortunately, because new diseases emerge, tests are never perfect, patients are sometimes non-compliant, and physicians will inevitably, at times, choose the most likely diagnosis over the correct one, illustrating the concept of necessary fallibility and the probabilistic nature of choosing a diagnosis.
Diagnosis is the result of a decision-making process made by physicians to identify patients’ diseases from their manifestation (signs, symptoms and diagnostics) before deciding the corresponding treatment. Depending on the type of patient and the amount of diseases he suffers from, diagnosis can become a difficult process.
Now lets look at the relationship of the manifestation and disease;
For an accurate diagnosis the manifestation has to be weighed on a disease scale keeping the context in mind. The improper description of the manifestation on this scale due to subjectivity both from the seeker end and the provider end causes a "No fault error".
Key questions however remain;
Can a diagnostic error occur if a condition is pre-emergent, i.e. asymptomatic? When does “time to diagnose” become a diagnostic error? Would diagnosis failure be more blame-free than error? Does missed diagnosis equal delayed diagnosis? What is Over-diagnosis? Is it misdiagnosis or misinterpretation?
