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Comment & Response
January 9, 2018

Improving Diagnostic Decisions—Reply

Author Affiliations
  • 1University of Chicago, Chicago, Illinois
JAMA. 2018;319(2):195. doi:10.1001/jama.2017.17732

In Reply Drs Patel and Bergl add to the dynamic factors that I cited in my Viewpoint as affecting diagnostic calibration, discussing topics such as fatigue, ambient conditions, and team dynamics. These factors absolutely play a role in diagnostic accuracy and are often referred to as part of “situativity” in the diagnostic reasoning literature.1

Their suggestion to conduct “cognitive and affective autopsies” is a reasonable one. Greater mindfulness is important in every aspect of clinical practice.2 Given the prevalence and cost of diagnostic errors, I believe it is time to move beyond proposing untested heuristics. It is possible that well-meaning interventions will help, but it is also possible that they will only waste the valuable time of physicians and distract students from learning the intricacies of medicine.

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