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Editor's Correspondence
Health Care Reform
January 24, 2011

Where Do Diagnostic Adverse Events Come From?

Author Affiliations

Author Affiliations: Mid-Valley Cardiology, Kingston, New York, and Division of Cardiology, Department of Medicine, New York University School of Medicine, New York.

Arch Intern Med. 2011;171(2):180-181. doi:10.1001/archinternmed.2010.504

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.