All our listeners are familiar with the archetype of the master diagnostician, probably best represented in pop culture by Dr. Greg House, the irascible, pill-popping doctor of the eponymous television series. Every week, House put together the clues and discarded the red herrings to come up with a diagnosis that only he could have thought of. It’s a great trick, and there are people out there who can really do it. Some even do it for their peers, at grand rounds that are akin to displays of medical prestidigitation.
But it’s about more than tricks. For instance, in April of this year, a Hopkins review of 25 years of malpractice claim payouts found that diagnostic errors—not surgical mistakes or medication errors—made up the largest fraction of claims, the greatest harm to patients, and the highest total payouts: almost $39 billion during that time. All this despite the common practice of defensive testing, in which tens of billions are spent each year on unnecessary tests in the hope of protecting doctors from the possibility of lawsuits.
Our guest on this episode is Dr. Gurpreet Dhaliwal, Associate Professor of Clinical Medicine at the University of California San Francisco School of Medicine. Among Dr. Dhaliwal’s professional interests are clinical reasoning, diagnosis and diagnostic errors, and how physicians can improve in those areas. He is also much less angry, and students Eric Wilson, Dwiju Kumar, and Alison Pletch found him a lot more fun to talk to, than Greg House.