Comment & Response |

Origins of Diagnostic Error—Reply

Hardeep Singh, MD, MPH1,2; Eric J. Thomas, MD, MPH3
[+] Author Affiliations
1Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
2Section 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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In Reply We welcome the opportunity to respond to Drs Norris and Iwasaki to clarify the premise of our study. Although our study did not directly comment on Lawrence Weed’s work, we recognize and admire his contributions. However, the reality is that it has been challenging to translate some of Dr Weed’s concepts to the frontlines of busy primary care settings with information systems that are not yet mature enough to provide adequate cognitive support to physicians.1 We believe it is neither futile nor too late to study diagnostic errors in real-world practice settings because empirical data are essential to validate and refine our conceptual understanding of the problem.2 For instance, although we acknowledge the limitations of any given individual’s medical knowledge, in fact it appears unlikely that knowledge deficits contributed substantially to the errors we observed, since most of the conditions missed were common diseases.


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November 11, 2013
David C. Norris, MD; Justin M. Iwasaki, MD, MPH
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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