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Physicians Lack Feedback on Accuracy of Diagnoses

Open-loop system robs physicians of information about successes and failures

TUESDAY, April 29 (HealthDay News) -- Clinical diagnosis is a largely open-loop system in which there is no systematic way for clinicians to obtain feedback on the outcome of their diagnoses, according to an article published in a supplement to the May issue of The American Journal of Medicine.

Gordon D. Schiff, M.D., of Brigham and Women's Hospital in Boston, examines the numerous barriers to feedback and follow-up in the current system of medical diagnosis, such as the lack of a system for doctors to get feedback, the reluctance of physicians to receive and offer criticism, the discontinuous nature of patient care, and reliance on patient return for follow-up. The barriers imposed by the system of managed care also discourage feedback, the author notes.

Acknowledging that diagnosis is not a label, but an intrinsic part of the physician-patient relationship, is an important aspect of establishing a mechanism for feedback, the author explains, as the patient should be seen as a partner in the process of testing the diagnostic hypothesis.

"Learning and feedback are inseparable. The old tools -- ad hoc fortuitous feedback, individual idiosyncratic systems to track patients, reliance on human memory and patient adherence to or initiating of follow-up appointments -- are too unreliable to be depended upon to ensure high quality in modern diagnosis," the author writes.

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