The hazards of diagnosis.
BACKGROUND
Making a diagnosis is perceived as a climax of clinical effort. Little consideration is being given to potential down sides after the diagnosis is achieved.


METHODS
The authors' personal experience, extensive discussions with peers and a search of the literature.


RESULTS
Several common and significant pitfalls after making a diagnosis were identified. They include 'locking' and disregard of further data pointing to possible diagnostic error; pursuing a diagnosis when further information has little practical significance; a severe impact of the news on the patient; a 'stigma' effect; loss of the patient's individual narrative; stopping the diagnosis short of the full pathogenesis or of its finer characterization; disregarding additional medical issues; losing interest in the patients once the diagnostic problem is solved; and assuming full control of future decisions at the expense of the patient's autonomy.


CONCLUSIONS
Physicians need to be cognizant of the impact and significant potential for harm associated with closure of diagnosis and its delivery to their patient. Humility, double-checking and sensitivity to the patient's predicament may improve quality and communication and prevent 'the hazards of diagnosis'.
Department of Medicine, Kaplan Medical Centre, POB 1, Rehovot, Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel. amimd@clalit.org.il
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Schattner
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Magazanik
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Haran
D001294:Attitude to Health; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations