> In ?25% of the extremely wel researched patients in one University > Hospital we not diagnosed correctly during their life time. > As could be concluded after an autopsy. > So what do we really know about disease and complaints? > What is certainty? > What is it refering to? > Do we understand this mine field well enough?
I recommend this book: "Decision making in health and medicine Integrating evidence and values" by M Hunink and P Glasziou. Speaking with experience from rheumatology and general practice in Norway, I agree that the state of the diagnosis in medical records is lousy. Just a few points: - as stated by Gerard, physicians very often come up with the wrong diagnosis, sometimes with fatal consequences. - how strong the physician believes in the diagnostic hypothesis is not stated explicitly. -- whether this certainty/probability is above or below the test-treat threshold (depends among others on the expected utility of the treatment) is not stated. -- whether this certainty/probability is above or below the no treat (wait) - test threshold - too many resources are spent on excuding differential diagnoses whose (pretest) probabilities already are below the no treat - test threshold --this to maintain the trust from the patient / avoid the risk of litigation. The actions of health care personnel have norms. What entity a "diagnosis" is can also be evaluated according to what the norms say it _should_ be. The diagnosis _ought_ to be an inferrence drawn from medical knowledge and information which stems from the patient. It is not the underlying disease but the physician's inferred diagnosis that form the basis of all health interventions. Because of this, it deserves to be represented as more than a subjective statement. In an EHR system, it should be possible to link the diagnosis statement with its underlying premises. It should also be possible to link the diagnosis to the set of plans/actions that follows as a consequence. This would lay the foundation for EHR systems that visualizes the consequences of physician's actions in a much better ways than in systems of today. regards Arild fax - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
