TY  - JOUR
T1  - WHere do diagnostic adverse events come from?—reply
AU  - Zwaan L, de Bruijne M, Wagner C, et al
Y1  - 2011/01/24
N1  - 10.1001/archinternmed.2010.505
JO  - Archives of Internal Medicine
SP  - 180
EP  - 181
VL  - 171
IS  - 2
N2  - 
We agree that evidence-based algorithms should not be followed blindly. Evidence-based algorithms represent the latest scientific findings and are therefore a valuable tool for diagnostic reasoning. However, as they are based on data from a large number of patients, these algorithms are not applicable to every patient and in every situation. It is thus particularly important for physicians to recognize the situations in which algorithms are not applicable. This implies that physicians, while diagnosing a patient, need to be aware of the whole context and should reflect on their thinking at the same time.1 For example, physicians are inclined to only look for data confirming their initial diagnosis. While this is often a good strategy, since it allows focusing on the most important examinations and tests, it sometimes leads to a diagnostic error, in particular when a patient reports symptoms not typical for the underlying disease. While making a diagnosis, physicians are not only bounded by limited cognitive capabilities, typical for the human being, but also by time and other constraints. This implies, and we believe this is in line with Dr Lader's remarks, that it is particularly important to study diagnostic reasoning in diverse situations with time and other constraints.

SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2010.505
UR  - http://dx.doi.org/10.1001/archinternmed.2010.505
ER  -