Happy New Year!  In reflecting on my blogging over the past year, I considered many issues.  The evidence against P4P continues to mount.  The biases in guideline development have gained more widespread interest  Retainer medicine continues to grow (and I co-authored an opinion piece on this topic in the Annals of Internal Medicine).  But diagnosis trumps everything as I plan for 2012.

I attended (and spoke during) the 4th Diagnostic Errors in Medicine meeting.  I plan to join the new Society that has grown from these meetings – The Society to Improve Diagnosis in Medicine.

My interest in this topic has grown over the past decade.  Recently I have paid increasing attention to this problem.  No performance measure has validity when diagnostic errors occur.  Much of the problem with the 4 hour and 6 hour pneumonia rules followed from these rules encouraging over diagnosis of pneumonia.  Over diagnosis of pneumonia leads to unnecessary antibiotic use.  Recently data have shown that the rule leads to an increase in C diff infections.

This year I rewrote my Grand Rounds to further discuss clinical reasoning, using adult pharyngitis as an example symptom.  My presentation includes a series of diagnostic errors.

This year also focused my interest in the Clinical Problem Solving exercise as a way to stimulate interest in clinical diagnosis.

Finally this year I read Daniel Kahneman’s new book – Thinking, Fast and Slow.  This book tells the story of the basic science of reasoning.  Often this year I wrote about the importance of history, physical exam, lab test interpretation and understanding imaging results in the diagnostic process.  Too often we focus our guidelines and performance measures on treatment.  The new society describes the importance of diagnosis as such:

We believe the answer is clear: Diagnostic error is the next frontier in patient safety. Diagnostic error is the largest cause of medical malpractice claims, especially for the top killers: cancer, stroke and heart disease. There is hardly an extended circle of family and friends that has not been touched by diagnostic error.

We can improve the teaching and practice of diagnosis.  We have a growing number of physicians dedicated to this task.  I challenge other medical bloggers to write a piece this week on diagnosis.  To modify a famous ad – Diagnosis is job One!