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.
Cifu AS. Improving Diagnostic Decisions—Reply. JAMA. 2018;319(2):195. doi:10.1001/jama.2017.17732