tag:blogger.com,1999:blog-2308282620289958037.post2580622991720205360..comments2023-08-08T08:41:19.586-04:00Comments on The Medical Contrarian: Diagnostic ErrorThe Medical Contrarianhttp://www.blogger.com/profile/09240492315542223258noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2308282620289958037.post-40179668416773942552012-11-20T20:20:43.417-05:002012-11-20T20:20:43.417-05:00One obvious source of bias in the composition of t...One obvious source of bias in the composition of the attendees in this conference is that, not surprisingly, absent were patients whose own acts or omissions delayed, obscured or obfuscated a correct diagnosis. To what extent does the encounter with such patients desensitize physicians to patients' historical input deterring engagements that would be diagnostically useful. <br /><br />Physicians, their protests to the contrary, have always been philosophically deontologists but operationally utilitarians in their practice of medicine. "Activated" physicians exist on a bell curve from the mercenaries to the missionaries. Intrinsically the current reimbursement climate coupled with the extrinsic tax and regulatory environment will make this more evident within the profession and make not a few doctors whose moral compass points due north become hardened cynics, shifting that curve to the left. This will exacerbate the task of accurate diagnosis for the economic reasons cited above. And physicians have always implicitly realized that the easiest way to increase their aggregate accuracy in diagnosing disease is to not see those patients who are a diagnostic challenge. That may become more explicit in coming years as physicians develop strategic incompetence to avoid difficult patients. CAMnoreply@blogger.com