Diagnosis is almost certainly the most difficult challenge in medicine. It demands a high level of accuracy and is both time and cost constrained. The aspects of diagnostic challenge can be broken down into three challenges:
- Cognitive: In addition to scientific and data analysis challenge, one must consider the financial costs associated with the process of making a diagnosis. This concern is especially important in an era of increasingly expensive tests, insurance requirements, and cost to the patient. The article also points out the difference between the approaches of intuition or pattern-recognition versus more scientific, fact-based decisions. A full discussion of different strategies toward diagnosis requires review of the literature on gist versus verbatim memory and is outside this discussion – we will include it later.
- Emotional: The diagnosis may have disturbing ramifications for the patient or their family. Also, the diagnosis can conflict with previous diagnoses as well as the current provider. A missed diagnosis leads to stress and self-doubt. There is a scale to assess the anxiety related to uncertainty. It is helpful to look at the personality factors related to making a diagnosis and resolution of anxiety related to the uncertainty of diagnosis. It appears that communication skills also are key to more accurate diagnosis and the reduction of anxiety.
- Ethical: The Hippocratic Oath paper discusses the potential conflict between this common oath as it conceived and implemented in today’s practice of medicine. That is, the struggle with the need to put the patient’s needs first versus the need to address economic models with a movement toward more corporate based healthcare delivery.
These challenges introduce a burden and stress. To that end, we have created the Clinical Encounters Platform and broader ecosystem to create and complete cases that assist in this process. The platform makes it easy to produce cases to improve clinical skills including diagnosis. Currently, the emphasis is mostly on improving and assessing success associated with the cognitive challenge of diagnosis, a clear source of stress. But the platform can also help investigate areas of diagnostic uncertainty and their impact on burnout.