I read with interest the article by Zwaan et al1 analyzing the causes of diagnostic adverse events (DAEs). They conclude that “knowledge-based mistakes” were the most common, but I believe that the real issues lie hidden behind the otherwise compelling statistics developed in the article.
We live in a setting where we increasingly see medicine practiced by protocol. That is not to say that compiling best-practice guidelines or evidence-based algorithms are bad, but what it encourages is a lack of “creative thinking” when seeing patients and more of a “cookbook approach.” Couple this with the increasing pressures to see more patients in a shorter period, to get patients out of the hospital faster, and to enforce a conformity of therapy in the name of “comparative effectiveness,” and we see DAEs because practitioners just are not encouraged to think creatively.
Lader E. Where Do Diagnostic Adverse Events Come From?. Arch Intern Med. 2011;171(2):180-181. doi:10.1001/archinternmed.2010.504