diagnostic error Archives | The Short Coat

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The feedback loop that would make doctors better diagnosticians doesn’t exist.

Louise walked five minutes. Then her legs turned to stone. She stood at the side of the road, waiting for them to work again—and nobody figured out why for thirty years.

Author and New York Times Health and Science Opinion Editor Alexandra Sifferlin has spent years as a journalist fielding emails from patients who couldn’t get a straight answer from medicine—not because their doctors were incompetent, but because diagnosis is harder, messier, and more difficult to do in 15 minutes than anyone wants to admit. Her book The Elusive Body: Patients, Doctors, and the Diagnosis Crisis traces the problem from rural Kentucky to the NIH’s Undiagnosed Diseases Network, and her conversation with M4 Jeff Goddard, M1 Madelyn Klemmensen, and M2 Zach Goddard goes deep on the mechanics of how diagnostic errors actually happen: availability bias, the missing feedback loop, specialty tunnel vision, and the slow erosion of trust that pushes patients toward people selling them supplements.

The students here aren’t just asking sympathetic questions, although Jeff is literally a character in the book, something Dave found out in real time on this episode. They push on the hard stuff: when is a placeholder diagnosis ethical, whether AI will save us or become a crutch, and what do you actually do about a healthcare system where the patient bounces between docs who don’t have answers. What they keep landing on is uncomfortable—medicine doesn’t have great solutions to this, but the relationship between patient and physician might matter more than the technology of medicine. Solving the diagnostic crisis might mean uncomfortable, expensive changes.

Episode credits:

Producer: Jeff Goddard
Co-hosts: Zach Grissom, Madelyn Klemmensen
Guest: Alexandra Sifferlin, https://www.alexandrasifferlin.com/
Production: SCP Media Lab–Anna Roger, Cyrus Barati, Isa Perez-Sandi, Zach Grissom, Sarah Upton, Srishti Mathur, David Lee, and Jacob Thompson

The views and opinions expressed on this podcast belong solely to the individuals who share them. They do not represent the positions of the University of Iowa, the Carver College of Medicine, or the State of Iowa. All discussions are intended for entertainment purposes only and should not be taken as professional, legal, financial, or medical advice. Nothing said on this podcast should be used to diagnose, treat, or prevent any medical condition. Always seek qualified professional guidance for personal decisions.

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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.

Dr. Dhaliwal does an unknown case presentation for medicine residents.

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.

Listen to Episode 027 – A real life Dr. House: Gurpreet Dhaliwal.

The opinions expressed in this feed and podcast are not those of the University of Iowa or the Roy J. and Lucille A. Carver College of Medicine.

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