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Comment & Response |

Origins of Diagnostic Error

David C. Norris, MD1; Justin M. Iwasaki, MD, MPH2
[+] Author Affiliations
1David Norris Consulting, LLC, Seattle, Washington
2Department of Family Medicine, University of Washington, Seattle
JAMA Intern Med. 2013;173(20):1925-1926. doi:10.1001/jamainternmed.2013.9718.
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To the Editor Singh and colleagues1 present findings of an elaborate and costly program to investigate diagnostic error in primary care. This report and the accompanying Invited Commentary2 miss the larger significance of the work presented.

The very ingenuity and scale of effort required to conduct this investigation by Singh et al1 documents the persistence in medical practice of the same, pervasive disorder described by Lawrence L. Weed a half-century ago.3 Best known as the inventor of the problem-oriented medical record and SOAP (subjective, objective, assessment, plan) note, Weed has labored 60 years to align medical practice with scientific methods. His work culminates in a comprehensive analysis of the disorder in medical practice, identifying its roots in our continued reliance on the physician “as a repository of knowledge and a vehicle for information processing.”4(pX) Far from being “the first step on a path forward,”2 the work of Singh and colleagues1 should herald our last missteps on a path of error defined by neglect of Weed’s thought.

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November 11, 2013
Hardeep Singh, MD, MPH; Eric J. Thomas, MD, MPH
1Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
3Division of General Medicine, Department of Medicine, University of Texas at Houston–Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School at Houston, Houston
JAMA Intern Med. 2013;173(20):1926-1927. doi:10.1001/jamainternmed.2013.9717.
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