Diagnoses by general practitioners: Accuracy and reliability

Measuring interdependence in ambulatory care

“…First, interdependence challenges our understanding of the clinical situation [2]. Such uncertainty increases the risk of missing potentially dangerous conditions and is a particular risk in primary care settings due to lack of clinical differentiation at presentation [15]. This uncertainty results in an inability to apply appropriate guidelines with predictable outcomes [42].…”

“…Although an established, validated approach to estimating complexity of care exists based upon the number of possible states a system can take [7], this approach does not assess interdependence within the system.from '0' and then decay exponentially, and are said to be 'fractal' and scale invariant, displaying similar dynamics across scale or magnification. Such power law distributions have been found in mental disorders [10,11], back pain [12,13] and health care utilization [14,15]. Although a variety of mechanisms could yield power law distributions, all involve interdependence [16].…”

Motivating Cooperation and Compliance with Authority

“…For example, expert radiologists are not consulted for extremely routine cases but only for the more diffi cult, high-risk cases, and the top national specialists may work almost exclusively on cases that other experts have been unable to resolve. In any case, the track record for prediction and control in the human sciences-business and economics (Makridakis, Hogarth, & Gaba, 2009 ), general medicine (Fink, Lipatov, & Konitzer, 2009 ), psychiatry and clinical psychology (Dawes, Faust, & Meehl, 1989 ), law (Goodman-Delahunty, Granhag, Hartwig, & Loftus, 2010 ), and political forecasting (Tetlock, 2005 )-is fairly discouraging, showing that significant errors are far from rare. In all these domains, data-based statistical models consistently outperform intuitive "clinical" expert judgments (Dawes et al, 1989 ), and these quantitative models are themselves a form of expertise.…”

Diagnostic protocols—A consultation tool still to be discovered

“…According to Aitken and Braun, the complex input finds a correlating output in different grades of diagnostic certainty, namely, 90% classify as symptoms, symptom groups, or “pictures” of diseases and only 10% as firm diagnoses . This 10/90 distribution of diagnostic certainty displays nonlinear (or Pareto) properties …”

“…2 This 10/90 distribution of diagnostic certainty displays nonlinear (or Pareto) properties. 3 The challenge in general practice is to always take common complaints seriously at the first presentation, despite time pressure and other constraints in daily practice, and not to forget asking relevant questions or performing necessary examinations. Finally, with respect to medical and legal requirements, it is important to document positive and negative findings of the consultation.…”