We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





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.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...