Friday, May 27, 2011

EPTAS after chapter 9

In this chapter, Sick Thinking, Dr. Sanders explores diagnostic error.
  1. How important is diagnostic error in the field of medicine? As a potential patient, are you worried about it? Do you think more research should be done around this issue? 
  2. What stood out for you in this chapter?
Please address the questions above before Saturday, May 28th.


  1. Diagnostic error is very important in the field of medicine because of its potentially life-controlling effect on the patient. Often, finding the right diagnosis is key in curing a sick person, therefore without the right diagnosis, it is difficult for a doctor (no matter how good or experienced) to help their sick patient. As a potential patient, I am worried about diagnostic error because of its monumental effect on healing the patient. I think that this topic can be very scary because if a person is very sick, he/she has to put his/her life in the hands of another person. Doctors are essentially in control of the lives of their patients, therefore, if I were a patient, it would be especially scary to realize that I did not have control over what happens medically. Considering different solutions that would prevent diagnostic error, I have found that although there may be ways to lessen the probability of diagnostic error, there is no concrete way of completely avoiding it. In some cases, even if a patient sees several doctors, they remain undiagnosed. I think that research on this issue should be expanded to make ways to lessen diagnostic error more evident.

    I think that in this chapter, the deep discussion regarding where diagnostic error can occur stood out to me. Dr. Sanders talked about faulty knowledge, faulty data gathering, and faulty synthesis were all part of the category causing diagnostic error called cognitive error. It was very surprising to see the broad amount of areas that can profoundly affect diagnoses.

  2. As Dorothy stated, diagnostic error is critical in medicine because you are putting the patient's actual lives at risk. I think that with any type of diagnostic error, whether it be system-related, fault knowledge, or cognitive, we can try to improve the accuracy of diagnoses by simply paying more attention to the whole process and not making assumptions. As a patient, I would definitely be concerned if I were diagnosed inaccurately. In both David’s case of pernicious anemia and Vera’s case of rheumatic fever, possibilities were rejected before they were even considered, simply because the doctor was either unfamiliar with the symptoms of the disease or had intuitively linked the cases with previous experience. It is also surprising that not only one but more than four doctors had acted in the same, hasty manner in dealing with these potentially serious medical issues. Although I think a little extra time spent in improving diagnostic tools, doctor-patient conversations, and basic diagnostic thought processes would aid somewhat in decreasing the rate of diagnostic error, I don’t think these percentages would ever be significantly changed.

    In this chapter, I was really interested in the specific cases introduced in these two patients. Even though I don’t know much about the numerous diseases one could have, Dr. Sanders makes it clear that these cases were not typical and that they were indeed difficult to not initially diagnose as something else. The medical field is certainly not an easy one, and often doctors can never be completely sure in their diagnoses and treatment for their patients. Although experience will probably improve a doctor’s ability to diagnose, there will always be those cases that are difficult (and sometimes impossible) to decipher.

  3. Diagnostic error, as seen in this chapter, is a huge part of medical practice. As Dr. Sanders mentioned, it accounts for about a third of all errors made. Sure, I'm kind of scared thinking that I could one of those errors someday, but there's really not much you can do about it. "To err is human", and doctors are definitely human. We can get mad at a doctor's "incompetency" all we want, but in the end, the doctor simply made a mistake. I think they were trying their best to help, and that sometimes things just go wrong.
    However, even saying all that, I was surprised by how many doctors actually rule out diagnoses because they weren't manifested in the "right" person. I mean, some diseases are typically found in one type of individual more than in others, but typically doesn't mean ALWAYS. So, I think it's surprising that biases and profiling occur in medicine, too.

  4. According to the chapter, diagnostic error seems to be important but overlooked in the field of medicine. It shocked me that in the study of autopsies, a full 20% of the patients autopsied were found to have been diagnosed incorrectly. Given how serious the consequences of diagnostic errors can be, and given how difficult they are to catch and how little attention (according to Dr. Sanders) they get from medical researchers, I am definitely worried about them as a potential patient. I was surprised that so little research has been done on the issue, and I'd definitely agree that more is necessary.

    What stood out for me in this chapter was the fine line between using nonmedical information about a patient in order to make a diagnosis more efficiently and using nonmedical information in a way that prevents the doctor from arriving at the right conclusion, that closes the doctor off to possible diagnoses. This really drove home the point that doctors are subject to the same kinds of human bias and judgment errors as everyone else. It also suggested to me that training doctors to be aware of their own limitations in thinking could be an important part of reducing diagnostic error.

  5. As everyone has previously stated, diagnostic error is a huge - and potentially life-threatening - factor in medicine. The influence the fallacy of a diagnosis can have on a patient's life is widely varied, but in all cases, it is crucial that the doctor pays very close attention to the whole process, to all of the details the patient gives, and that the doctor uses all of the information available to make a diagnosis (instead of making assumptions, as Alyssa said). Considering that the patient is simply expected to give information (from testing and by directly talking to the doctor) and then trust the doctor's diagnosis, it is very hard to be able to have trust that the conclusion the doctor settles upon is the right one; of course, patients SHOULD have faith in their doctors (they are surely qualified), yet, something about puttint your life into someone else's hands and hoping they make the correct decision puts us in a very helpless position. It is an extremely scary - albeit usually reliable - system. But like Jlor brought up, humans make mistakes, so there is always the chance of a misdiagnosis to keep us worrying.
    In this chapter, I was especially surprised by the FOUR doctors who misdiagnosed the cases brought up by Sanders, due to their assumptions and hasty decisions. Of course, these four doctors are not at all an accurate microcosmical representation of all of the doctors in the world, but discussing these four doctors' failures in the same chapter was really striking. Of course, doctors do learn by experience, and techonology is evolving and always being bettered, but there will forever be those cases that are too vague or difficult to ensure a correct diagnosis - that's the inherent flaw in the realm of medicine. Cases are so broad, the possible misdiagnoses so numbered, and the human body so enigmatic and frequently unpredictable (despite the significant medical advances that are constantly taking place), that a world free of diagnostic error is impossible.

  6. I think that diagnostic errors are a definite problem in the medical field because, as Dr. Sanders has made a point of throughout the book, they occur much more frequently than might be expected. From the different cases that Dr. Sanders presents, it seems to me that the most probable reason for diagnostic errors is that the doctors are either unfamiliar with the symptoms or are not thorough enough when performing physical exams because they were over confident in their ability to identify symptoms of certain illnesses. In a question of life or death, as a patient, I would want to have complete trust in my doctor's decisions and know that they were taking the correct measures to help my condition. While it is understandable that doctors will make mistakes occasionally, it is also important to recognize when a mistake could have been avoided by paying attention to all of the details of a case because that could prevent the same errors from repeating.
    What I found most interesting in this chapter was, as Jlor mentioned, the fact that gender, race, and physical description can affect the doctor's diagnosis even if the symptoms match, based on the genetic probability that a person would contract a certain illness. In Vera Freeman's case, Rheumatic Fever seemed to be the most probable cause, but the genetic probability that she would have it, according to tests run, was only 68%. I thought this was interesting because while Vera was correctly diagnosed, some patients might be given different diagnoses than what is originally thought and most likely correct, simply because their genetic probability convinces the doctors to choose another "more fitting" diagnosis.

  7. Diagnostic error, which includes missed, delayed, or wrong diagnoses, is an enormous issue in the medical field. They are especially important because of life-threatening possible consequences. Yes, I would say I am pretty nervous about diagnostic errors, especially after reading these example stories. In our society, we often portray doctors as life-saving heroes and hospitals and safe havens; it is a bit scary to realize that they are prone to mistakes, and even scarier to realize that the mistake could cost a patient’s life. I definitely think more research should be done on this issue. The more we know, the more we can start eliminating errors. Steps should be taken to decrease number of “system-related errors” - ones caused by equipment failures or problems with the medical system. Cognitive errors, although harder to analyze, should definitely also be investigated further. Faulty data gathering and faulty synthesis, which account for many of the cognitive diagnostic errors, are areas that can be improved through attempting to eradicate doctors’ assumptions and rushed assessments.

    The statistics of this chapter stood out the most to me. I thought the results of one study were especially shocking: 20 % of autopsy findings discovered diagnostic discrepancies - where the diagnosis given to the patient was inconsistent with the diagnosis discovered after death. This statistic shows just how prevalent of an issue diagnostic errors are in the medical field. In addition, around 10% of diagnostic errors caused avoidable suffering and death. These unnervingly high numbers pose a serious problem that must be evaluated further.

  8. It seems to me after reading this chapter that diagnostic error is hugely important in the field of medicine. The statistics that Sanders gives about the frequency of diagnostic error were shockingly large. As a patient, I think though I'd only be worried if I was being treated for a serious illness. Diagnostic errors are unavoidable as Sanders demonstrates about her vignette about intubating the esophagus. As she goes on to reflect though, the mistake is in not catching these unavoidable errors, rather than simply making them. I think this is part of why patients themselves have so much responsibility in their own treatment. Patients do not have the diagnostic skills that a doctor has, but they can keep track of their symptoms and progress to make sure they are recovering successfully, and if they are not, they can work to find another doctor. As a patient I would work to be on the lookout for diagnostic errors, but I don't think I would worry too much about them unless my symptoms seemed unrelenting or life-threatening. I certainly think that more research should be done into the topic however, because these errors can cost many lives.
    Sanders' discussion of profiling in medicine in this chapter was particularly interesting to me. She makes the point that some element of profiling is necessary in medicine, since certain diseases strike people in patterns based around age, race, and gender. As Sanders' states, it would have been egregious to profile someone based on a factor unrelated to diagnosis, but some bias is quite legitimate. I was interested to learn about Sanders' views on this type of profiling, and also how necessary it is in some types of diagnosis (given her example of prostate cancer risks based on ethnicity).

  9. Diagnostic errors are important in several ways. Unfortunately, as others have said, they account for 1/3 of medical mistakes made. They can prolong or even exacerbate a disease and cause patient distress. It's only natural to have concern about being the victim of a diagnostic mistake. But I think there are some ways for patients to help reduce that risk: providing complete medical histories, asserting their right to a doctor's full attention, etc. Furthermore I think that diagnostic mistakes can actually have benefit in the long run. Once a doctor has made a mistake, they are much less likely to make that mistake again, and they will most likely keep an eye on their colleagues to make sure they don't make that mistake either. Though of course making a mistake puts lives on the line and should be avoided with diligence, if a doctor does err he/she should learn from that case rather than dwell on what they did wrong. Patients should never be made purposeful victims, of course not, but  making a mistake is probably the most powerful way in which doctors can become better at their job.
    What stood out to me was the importance of eliminating possible diagnoses and how easily that can mess up the medical process. If I were a doctor, I'd always be worried that I was dismissing a possibility too easily. It's true that there are too many potential diagnoses in any given case to NOT eliminate as many as possible for the sake of efficiency. But on the other hand, using somewhat indeterminate criteria to decide that someone isn't "likely" to have a disease ignores the fact that there are by definition "less likely" cases.

  10. As many have said before, diagnostic error is an incredibly important part of the medical field, because of the incredibly dramatic effects it can have. A misdiagnosis not only delays the process of administering the correct treatment to the patient, but also runs the risk of being potentially fatal for the patient, if the given treatment interacts adversely with his or her current condition. As a patient, I would definitely have a certain level of anxiety about diagnostic error. However, there is an implicit trust between a doctor and a patient, where the doctor trusts the patient to disclose all information, and the patient trusts the doctor to make a diagnosis to the best of his or her ability. To that end, I don't think becoming paranoid about diagnostic error is necessary; rather, as a patient, all one can do to prevent diagnostic error is to be extraordinarily candid about symptoms, and trust that the doctor is doing his or her best. I believe that misdiagnosis is inevitable, and no matter how much technology progresses, doctors will always make mistakes in diagnosing a patient. Other than putting more resources towards training doctors both in the intricacies of various ailments as well as training them on how to properly integrate technology and lab testing into their diagnosis, there is no real way to prevent misdiagnosis.

    Like others have said, Sanders' discussion about the role of profiling in the diagnostic process was particularly interesting. To a certain extent, profiling provides a bit of a conundrum. On one hand, doctors should be able to objectively see a patient and his or her symptoms and piece together a diagnosis without putting undue weight on the profile of the patient. In contrast, doctors should use all information available to help them reach a diagnosis, and if they find something in the profile that, in conjunction with symptoms, seems to suggest a particular disease, would it not be smart to use that as a diagnostic tool? I think that profiling should be used with caution, because while it can provide a valuable clue to a diagnosis, doctors should be weary of relying on it too heavily, which could cause them to become blind to the real cause of the disease.

  11. I think the issue of diagnostic error is very crucial to the field of medicine, and I think it’s definitely something that should be addressed and further researched, especially given the statistic Sanders states: that 20% of autopsies have diagnostic discrepancies. However, it seems like a tricky area to research, as a successful diagnosis requires not only textbook knowledge but also intuition and a particular way of thinking. As a potential patient I actually do worry a fair amount about this, seeing as my own mother has had experience with a missed diagnosis; her doctor sent off blood test after blood test thinking her ailment was anemia-related, and she herself had to figure out what was wrong.
    What stood out to me in this chapter was Sanders’ own experience in error (intubating the esophagus instead of the lungs). The fact that she checked for and caught her error was significant, and drove home the point that while there may be some mistakes that are unavoidable, the only bad mistake is a mental mistake. Being able to analyze and adapt to what you learn is a very important part of making a diagnosis, and simply going through the motions is not enough.

  12. In this chapter, Sanders pointed out how diagnostic error plagues doctors and patients alike. Diagnosis, as Sanders has shown consistently throughout the book, is the most important step in medicine. Logically, it follows that diagnostic error is extremely important to medicine. Sanders states through one study of diagnostic errors, made by Mark Graber, how a quarter of all diagnostic errors are made through “cognitive error.” Further, that half of those errors (of the quarter) were because of the doctor’s inability to synthesize all the elements of making a diagnosis (making sense of symptoms, knowledge of doctor, understanding story). Indeed, Sanders has pointed out in this chapter how doctors can err, sometime severely (as in the case with David Powell). I am very worried. I used to believe that doctors were almost infallible. It’s common knowledge that doctors are extremely well educated. However, I wonder now how much education has done for doctors. Certainly, they have extensive knowledge of diseases, but I now realize that their ability to approach and analyze problems is not much different from anyone else’s, although experience helps a lot (as shown with Dr. Podell). More research on this subject needs to be done. I think it’s clear enough that doctors make mistakes, we should do more research on how doctors can double check their diagnoses.
    Probably the event that was most significant to me was the diagnosis of Vera Freeman, the crack addict and prostitute. I can only imagine the amount of prejudice against Vera. "Crack-addict prostitute" carries a huge amount of stigma. It’s no wonder to me that gonorrhea was the preferred diagnosis. In fact, Sanders makes the point that prejudice is necessary in medicine to make diagnoses more efficient. However, I agree most with Sanders opinion: that the most important quality about assumptions in medicine is that they must be justified, at least in part, by symptoms and tests that affirm an assumption based on race, class, etc.

  13. I think the problem of misdiagnosis is big but unavoidable. No matter how much extra time and effort were to go into improving the diagnosing process I think there would still be a lot of room for error. Medicine can be very subjective and doctors can sometimes have tunnel vision when it comes to patients' symptoms. With these problems in mind, fixing the problem of misdiagnosis seems impossible and unlikely. As a potential patient I suppose this bothers me a little because it could be life-threatening but it does not really worry me very much. I know that whatever doctor Id go to would have had sufficient training and any mistakes along the way would just be chance.

    I thought it was really interesting how much biases and patient profiling affect the diagnosing process, which we already know is an imperfect one. Ruling out a possible diagnosis in a patient because it is unlikely that it will appear in a patient of that age/gender/race/etc. seems a little irresponsible on the doctor's part. One way I think the diagnosing process could be improved, even if only a little bit, is if doctors were not so hasty to dismiss possible diagnoses before they were certain it wasn't it.

  14. I agree with liana, while misdiagnosis is an issue that should be taken in all seriousness, it is also an issue that is almost unavoidable even with advancing technology and new practices. And yes, misdiagnosed is terrifying (esp. in severe and demanding cases) but this is the risk everyone takes when we step into a doctors office. we all know it exists, the scary part is confronting and acknowledging the possibility it can happen to us.

    I thought it was extremely interesting to learn about the emotional and subjective side of medicine. i often relate misdiagnosis to carelessness, but in fact it can be the effect of pure prejudice or bias. this is not to say that it is an any way it is the product of a bad doctor but just seeing how much of a doctors visions and morals go into such a dry and emotionless process makes me look differently at doctors.

  15. Diagnostic error is a huge problem in the medical community. Dr. Sanders explains that around 20% of autopsies prove incorrect diagnosis or incomplete diagnosis. We certainly need to address this issue, since diagnostics play a crucial, life-or-death role in hospitals and doctors offices. In some cases, an incorrect diagnosis could even mean dangerous treatments and undue expense. Even before reading this chapter or this book, I had been very wary of the diagnostic process. I always asked myself, "can I trust this person, possibly with my life?" Fortunately, I've never been in the situation where a fast accurate diagnosis was necessary, but I can imagine how diagnostic error would be a very frightening threat, and indeed a very scary reality for uncountable numbers of people. That being said, however, I believe that in some cases it is necessary for doctors to make hasty decisions without looking back, for the good of the patient. All too often (as Dr. Sanders discusses earlier in the book) doctors over test and over analyze before making a diagnosis so as to prevent malpractice lawsuits. Of course doctors might make an incorrect diagnosis here an there; as Jlor said, to err is human. We can't punish every doctor who has made a mistake. Indeed this would mean the vast majority of doctors would be out of work. Instead I believe we should focus on trying to fix current problems, and perhaps lowering that percentage (but we shouldn't dwell on it). Only when a single doctor repeatedly makes life threatening mistakes should his or her abilities be called into question. If we don't trust our doctors, we may be less inclined to listen to their advice, and failure rates will be even higher. So while diagnostic error is a huge issue, we, as patients, should still value every doctor's opinion, be it right or wrong.

    I found the discussion of diagnostic profiling to be very intriguing. It reminds me a little of racial profiling and the law in Arizona: if you look a certain way, you can be pulled over without reason. In this same way, medical professionals often rule out a diagnosis or promote a diagnosis based on certain criteria. In many respects this makes sense: if one section of the population is more likely to get a given disease, that disease should be checked for first. This is good, it hedges a doctor's bets of getting the right diagnosis. So while I disagree with that Arizona law, I completely agree with the idea that doctors should check for certain diseases first given varying criteria. Problems only arise when doctors narrow their vision and only think of the diseases which commonly affect a certain group, or when doctors rule something out entirely just because it's not common in a certain group. That is where you get in trouble. Other than that I think it's good to consider race/age/gender/body-type and all the other "groups" when making a diagnosis, just so long as you don't limit yourself by these ideas.

    (Note to Ms. Doering) -- Sorry this is a bit ramble-y; my brain doesn't work quite as well at 11 at night. Hopefully my ideas still get across in one way or another)

  16. In this chapter, Dr Sanders discusses diagnostic error. I am really shocked to find out the report by Dr Graber showing the different types of errors- the system errors and the cognitive errors. The system errors could be fixed by having better communications among physicians and facilities. The cognitive errors are much harder to tackle. Doctors are humans and are entitled to have biases. As a matter of fact, some of the diagnoses are made based on biases-sex, racial background etc. On the other hand, in a profession where errors could be fatal, it is hard to condone such errors as to be expected. I feel that more research needs to be done around this topic. The medical community should also be made aware that such errors exist. While it is difficult to change a doctor’s thinking, there are measures that provide more protection for the patients. Doctors should be monitored more frequently to ensure that the fund of knowledge is adequate and up-to-date. There should also be measures to make sure doctors are not being overworked so that they have enough time and energy to go over each patient as objectively as possible.

  17. - Dan Cohen period 4

    Medical error and malpractices were an extremely interesting part of medicine for me before reading this interesting chapter. It was very interesting for me to find out that medical errors may happen as much as 10% of the time! Wow. Even with all the training, expertise and experience that doctors have, they still make mistakes like the rest of us. In the field of medicine, the diagnostic error is extremely relevant and important. An effective treatment always starts with a correct diagnosis and if a doctor has "sick thinking" there is virtually no chance that a correct diagnosis will be made. As a potential patient, it is a little worrisome but overall I trust my doctors and actually have to rely on them for some situations.

    I thought that Dr. Sander's experience in dealing with medical errors was very interesting. I thought her recommendation that doctors make errors but then be able to catch themselves or correct the error itself was very helpful in understanding what goes into making an error. She makes an important distinction between doctors that make errors and do not realize it and doctors that made errors and realize their mistake. This is key and very interesting

  18. This chapter contained several surprises. First, i had no idea that system errors accounted for so much of misdiagnosises. secondly, i was surprised by how much doctors seemed to fall victim to what Dr. Sanders called "premature closure", when they settle on a single diagnosis after hearing only a small portion of the patient's story. however, i no very worried about human error among doctors. first, there is clearly a great deal of effort being expended to solve many of the problems, and second, everythingwe do has a degree of human error involved. worrying about it would be silly.

    What stood out for me in this chapter was the various methods that doctors are using to eliminate human error. before reading this, i assumed that such mistakes were inevitable, and that most people would just decide they were there to sty. it's heartening to hear that people can solve these types of problems.

  19. As a potential patient, I am concerned by the prevalence of diagnostic errors and the widespread research done on various errors, yet by reading through these individual patient's stories, it is evident that the majority of doctors have not modified their procedures to avoid common errors. The "system related errors" are inevitably going to occur, and it seemed that there has been steps taken to avoid these errors that come from a heavy reliance or misinterpretation of lab and statistical data. What is more concerning is the "cognitive errors." It is human nature to be prejudiced towards a certain diagnosis after seeing that other doctors have come to the same conclusion. It is easier, takes less effort, and sidesteps the possibility of making a wrong guess at the disease. However, each doctor should be conscious of this natural habit and try to avoid looking at past reports until after coming to his/her own conclusion. The other cognitive error that comes from biases towards gender, race, age, socioeconomic class, etc. also makes sense in that it can help doctors quickly identify a common illness. However once this cheat step has been taken, it is important to reevaluate and again come to an independent conclusion.

    What stood out for me in this chapter was Dr. Sanders' conclusion that to make errors is human, but to be able to check for errors and modify procedures once an error is detected helps solve for diagnostic errors and saves lives.

  20. As a potential patient, I think diagnostic errors are a serious issue. I think that doctors get lazy and that when they see issues, they jump to conclusions because they think it makes them look smarter or more qualified. This is not okay. I think a reason this is becoming more prominent is because computers are taking the jobs of many humans. They are getting lazy and they are relying heavily on simple facts rather than the broader aspects of patients. Of course, there are always going to be errors, but I think that more research should go into this issue. It is not okay that people are dying even when doctors claim that they have a diagnosis for a patient. "Premature closure" can be avoided easily. All doctors have to do is pay more attention to the patients and not jump to misguided conclusions.

  21. Diagnostic error, like others have said, is a huge issue in the field of medicine. The information given by Dr. Sanders about the frequency of diagnostic error was much larger than expected. As a potential patient of course I am worried about it, a correct diagnosis of a patient means they can be treated quickly and efficiently, however if there is an error in diagnosis it can lead to many problems and even death of a patent. Others have said that doctors learn from their mistakes and the mistakes of other doctors and I believe that to be true, as time goes on doctors will learn.

    Something that stood out to me was how doctors will test people for different things based off race, age, etc. This profiling seems like a necessary thing for doctors as some diseases are more prevalent in certain races and etc.

  22. Diagnostic error is a significant part of the medical field as it poses a large issue because, as Dr. Sanders states, it accounts for about one third of medical mistakes and can result in harmful or deadly consequences. I am definitely worried about this as a potential patient. Growing up I’ve always thought about doctors as all knowing figures that would know what was wrong with me and be able to find a solution. These examples make one realize that doctors are human and their analytical perspective is one that is flawed with imperfections. Doing more research of diseases could help lessen the frequency of this problem but then again trial and error could prove even more effective because doctors would be less likely to make the same mistake twice. The fact that prejudice and bias can be such significant factors in misdiagnosis was interesting to me, especially since sanders has always focused on patients not giving enough information or doctors misinterpreting symptoms,

  23. As a potential patient, i find that these diagnostic errors are a worrisome issue. I feel that doctors are becoming too comfortable with results obtained by computers, or previous conclusions made by previous doctors in their cases (or "cognitive errors"). By becoming too comfortable with these ways of coming to their own diagnosis, doctors no longer see or feel the necessity in double checking, or reevaluating. However i do agree with doctor Sanders's point, that making errors is human, but it is still important to reevaluate and modify procedures. But the part about how making errors is human is what i found most interesting.
    By hearing of how emotional behavior can sometimes be an inevitable factor, such as bias or preconceptions/prejudgement, made me see doctors as more human and less of a god-like knowing all figure, which is how they should be perceived. If looking at doctors as all-knowing, a patient is unaware of the risk of receiving a wrong diagnosis,and therefore, if found in that position, the patient is caught off guard and is left with feelings of untrust towards doctors.
    While some errors can be avoided by the simple 1st grade rule of double checking, other errors are sometimes inevitable simply because a doctor is human, just like all of us.

  24. Diagnostic errors as I hear them and Diagnostic errors as Dr. Sanders presents them are different. Having a surgeon in the family I completely understand the staggering figures of diagnostic errors as a whole. "1/3" of medical errors apparently come from diagnostic errors as Dr. Sanders presents. However after watching patients from diagnosis to surgery to recovery, I believe that many of the errors in diagnosis also lead to further complications (wrong diagnosis, wrong treatment, deadly result.)
    Personally, believing in and trusting my doctor to know what to do is essential in building a trusting relationship. The book makes a valid point about errors, but what stood out for me in this chapter was that examining a few bad cases can make the overall situation look bad. The doctor is human. But as discussed in previous chapters, technology, double checking, and physical exams can curtail many of these issues.

    This was my favorite chapter.