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5 Antidotes to Diagnostic Uncertainty

5 Antidotes to Diagnostic Uncertainty


  • Medicine is a science of uncertainty and an art of probability.—Sir William Osler

  • Second Opinions, Second Chances. In a retrospective study, patients’ referral diagnoses were the same as their final diagnoses in only 12% of cases. Final diagnoses were “better defined/refined” and “distinctly different” in 66% and 21% of cases, respectively. Total costs were significantly higher for cases with different final diagnoses. Researchers noted that misdiagnoses often result in treatment delays and complications and second opinions offer good second chances to get the diagnosis right.

  • A Tool to Detect Serious Disease. Diagnostic protocols (DPs) can help primary care physicians manage complex patient presentations. For a structured recording of complaints, 82 DPs were developed, and in 320 consultations for other complaints, 43 were applied. Used most frequently: the “tabula diagnostica” for undifferentiated symptoms, headache, dizziness, precordial pain, and nonspecific abdominal pain. The findings could help physicians better handle common complaints that have a low diagnostic yield.

  • Going Beyond Breast Cancer Screening Recommendations. More than 80% of surveyed primary care physicians recommended screening mammography to women aged 40 to 44 years, even though the American Cancer Society and USPSTF do not, citing greater potential harms than benefit. Possible reasons: many US physicians do not follow evidence-based guidelines and payment systems typically reward ordering tests. Authors suggested that many women would not want to be screened if told that mammograms can be harmful.

  • Individualize Prostate Cancer Screening. Clinicians should inform men aged 55 to 69 years about the potential benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer, according to the latest USPSTF recommendations, which emphasize individualized decision-making about screening. The USPSTF recommends against PSA-based screening for prostate cancer in men aged 70 years and older.

  • Stroke, Telestroke. Telestroke—the use of interactive videoconferencing technologies for patients with acute stroke—can bring expertise to more patients who have the condition. The American Telemedicine Association practice guidelines published in March 2017 help practitioners provide assessment, diagnosis, management, and remote consultation to patients who exhibit the signs and symptoms. Stroke, the fifth most common cause of death worldwide, is the leading cause of long-term adult disability.

It’s often said that the one thing that’s certain is uncertainty, and that certainly is true in making diagnoses in medical practice.

Diagnostic uncertainty is said to be especially common in general practice. Some reasons why: (1) The typically low prevalence of serious diseases in a community population weakens the overall predictive value of diagnostic tests; (2) Most disease that presents in general practice does so in its early stages, before many “red flag” symptoms appear; (3) Many tests are predictive of a symptom that presents in many diseases; (4) Combined, these factors leave primary care physicians with a limited selection of useful diagnostic tools.

New tools, perspectives, and guidelines for minimizing diagnostic uncertainty have been reported in recent days. Click on the slides above for the latest findings.

 

Sources

Diagnostic uncertainty common in general practice

Second Opinions, Second Chances

A Tool to Detect Serious Disease

Individualize Prostate Cancer Screening

Going Beyond Breast Cancer Screening Recommendations

Stroke, Telestroke

 

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