All attempts at measuring quality in medicine depend on correct diagnosis. Diagnostic accuracy represents the lynchpin of high quality care.
As everyone knows, the first US Ebola diagnosed patient visited an emergency department at the onset of his illness, but did not get diagnosed properly or admitted to the hospital.
Few doctors would have made the proper diagnosis in this situation. We must accept that diagnostic errors are common. This situation was particularly difficult because very few physicians in the US had previously seen a patient with Ebola.
In order to make a diagnosis, you must consider that diagnosis. The patient likely presented with classic viral symptoms.
Talking heads now opine that the doctors should have taken a better travel history, and that the travel history would have given the clue. That is a very easy but naive belief.
We rarely make diagnoses for which we do not have a high index of suspicion.
This example of diagnostic error should alert everyone to the importance of accurate diagnosis. We all know the potential problem that this patient may have created – a mini-epidemic from one patient.
Accurate diagnosis is the precursor to high quality care. We cannot measure physician quality without considering diagnosis. Unfortunately diagnostic accuracy is very difficult to measure. And there lies the conundrum of high quality care.
