Diagnosing diagnostic failure.

Diagnostic failure results from misplaced dependence on the clinical judgments of expert physicians. The remedy for diagnostic failure involves defining standards of care for managing clinical information (medical knowledge and patient data), and implementing those standards with information tools designed for that purpose. These standards and tools are external to the minds of physicians, thus bypassing two inherent constraints on human cognition: limited capacities for information retrieval and processing, and innate heuristics and biases. Medical education and credentialing socialize physicians into misplaced acceptance of these constraints. Medical students acquire scientific knowledge, but not scientific behaviors. A scientific approach to diagnosis begins with using information tools to identify all diagnostic possibilities for the presenting problem and the initial findings needed to determine which possibilities are worth investigating in the patient. If the initial findings do not reveal a clear diagnostic solution, then information tools must be employed as part of a system of care to enforce highly organized follow-up processes, that is, careful problem definition, planning, execution, feedback, and corrective action over time, all documented under strict standards of care for managing the complexities involved.