An investigation into method of diagnosis in clinicopathologic conferences (CPCs)
-
Bimal Jain
Abstract
An analysis of 50 clinicopathologic conferences (CPCs) reveals the method of diagnosis in them to consist of construction of exhaustive differential diagnosis followed by evaluation of each disease in it by the likelihood inference approach. This method leads to 98% diagnostic accuracy in these CPCs. A probabilistic approach is found not to be employed for evaluation of a disease.
Author contributions: The author has accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Eikermann M, Velmahos G, Abbara S, Huang PL, Fagan SP, Hirschberg RE, et al. Case records of the Massachusetts General Hospital (Case 11-2014). A man with traumatic injuries after a bomb explosion at the Boston Marathon. N Engl J Med 2014;370:1441–51.10.1056/NEJMcpc1314240Suche in Google Scholar PubMed
2. Blanchard MS, Romero JM, Hoang MP. Case records of the Massachusetts General Hospital (Case 1-2014). A 32-year-old man with loss of vision and a rash. N Engl J Med 2014;370:159–66.10.1056/NEJMcpc1214217Suche in Google Scholar PubMed
3. Moskowitz SM, Shailam R, Mark EJ. Case records of the Massachusetts General Hospital (Case 25-2015). An 8-year-old girl with a chest-wall mass and a pleural effusion. N Engl J Med 2015;373:657–67.10.1056/NEJMcpc1400836Suche in Google Scholar PubMed
4. Dudzinski DM, Prabhakar AM, Ptaszek LM, Vlahakes GJ. Case records of the Massachusetts General Hospital (Case 19-2015). A 71-year-old man with chest pain and shortness of breath. N Engl J Med 2015;372:2438–46.10.1056/NEJMcpc1415757Suche in Google Scholar PubMed
5. Fisher MC, Stone JH, Palmer WE. Case records of the Massachusetts General Hospital (Case 31-2014). A 50-year-old man with back pain, fatigue, weight loss, and knee swelling. N Engl J Med 2014;371:1447–55.10.1056/NEJMcpc1404517Suche in Google Scholar PubMed
6. Pukkila-Worley R, Nardi V, Branda JA. Case records of the Massachusetts General Hospital (Case 28-2014). A 39-year-old man with a rash, headache, fever, nausea, and photophobia. N Engl J Med 2014;371:1051–60.10.1056/NEJMcpc1405886Suche in Google Scholar PubMed
7. Cooper CM, Baron JM. Case records of the Massachusetts General Hospital (Case 4-2015). A 49-year-old man with obtundation followed by agitation and acidosis. N Engl J Med 2015;372:465–73.10.1056/NEJMcpc1410940Suche in Google Scholar PubMed
8. Ray A, Muse VV, Boyer DF. Case Records of the Massachusetts General Hospital (Case 4-2013). A 30-year-old man with fever and lymphadenopathy. N Engl J Med 2013;369:2333–43.10.1056/NEJMcpc1310002Suche in Google Scholar PubMed
9. Chiappa V, Chang CY, Sellas MI, Pierce VM, Kradin RL. Case records of the Massachusetts General Hospital (Case 10-2014). A 45-year-old man with a rash. N Engl J Med 2014;370:1238–48.10.1056/NEJMcpc1304162Suche in Google Scholar PubMed
10. Iyasere CA, Simmons LH, Fintelmann FJ, Dighe AS. Case records of the Massachusetts General Hospital (Case 38-2014). An 87-year-old man with sore throat, hoarseness, fatigue, and dyspnea. N Engl J Med 2014;371:2321–27.10.1056/NEJMcpc1410935Suche in Google Scholar PubMed
11. Friedman LS, Simmons LH, Goldman RH, Sohani AR. Case records of the Massachusetts General Hospital (Case 12-2014). A 59-year-old man with fatigue, abdominal pain, anemia, and abnormal liver function. N Engl J Med 2014;370:1542–50.10.1056/NEJMcpc1314242Suche in Google Scholar PubMed
12. Pawitan Y. In all likelihood: statistical modeling and inference using likelihood. Oxford: Oxford University Press, 2001.10.1093/oso/9780198507659.001.0001Suche in Google Scholar
13. Finn KM, Ginns LC, Robbins GK, Wu CC, Branda JA. Case records of the Massachusetts General Hospital (Case 20-2014). A 65-year-old man with dyspnea and progressively worsening lung disease. N Engl J Med 2014;370:2521–30.10.1056/NEJMcpc1400841Suche in Google Scholar PubMed
14. Hunt DP, Sahani DV, Corey KE, Masia R. Case records of the Massachusetts General Hospital (Case 30-2014). A 29-year-old man with diarrhea, nausea, and weight loss. N Engl J Med 2014;371:1238–47.10.1056/NEJMcpc1405218Suche in Google Scholar PubMed
15. Edwards AW. Likelihood, expanded edition. Baltimore, MD: Johns Hopkins University Press, 1992.Suche in Google Scholar
16. Ramsey FP. Quoted in Edwards AWF, Likelihood, expanded edition. Baltimore: The Johns Hopkins University Press, 1992:27.Suche in Google Scholar
17. Weinstein MC, Fineberg HV. Clinical decision analysis. Philadelphia, PA: WB Saunders Company, 1980.Suche in Google Scholar
18. Riches N, Panagioti M, Rahul A, Cheraghi-Sohi S, Campbell S, Esmail A, et al. The effectiveness of electronic differential diagnoses (DDX) generators: a systematic review and meta-analysis. PLoS One 2016;11:e0148991.10.1371/journal.pone.0148991Suche in Google Scholar PubMed PubMed Central
19. Graber ML, Mathew A. performance of a web-based clinical diagnosis support system for internists. J Gen Int Med 2008;23(Suppl 1);37–40.10.1007/s11606-007-0271-8Suche in Google Scholar PubMed PubMed Central
©2016 by De Gruyter
Artikel in diesem Heft
- Frontmatter
- Opinion Paper
- Healthcare is a giant with feet of clay
- Original Articles
- Diagnosis is a team sport – partnering with allied health professionals to reduce diagnostic errors
- An investigation into method of diagnosis in clinicopathologic conferences (CPCs)
- Primary care pediatricians’ interest in diagnostic error reduction
- Spurious elevation of serum potassium concentration measured in samples with thrombocytosis
- Mobile phone exposure influences some erythrocytes parameters in vitro. A novel source of preanalytical variability?
- Case Reports
- Those eyes don’t lie: a case of osmotic demyelination syndrome in a patient with hepatic encephalopathy
- CA-125: What does that lab really mean?
- Letter to the Editor
- Assessment of reticulated platelets with automated hemocytometers: are we measuring the same thing?
- Congress Abstracts
- Diagnostic Error in Medicine 1st European Conference June 30–July 1, 2016
Artikel in diesem Heft
- Frontmatter
- Opinion Paper
- Healthcare is a giant with feet of clay
- Original Articles
- Diagnosis is a team sport – partnering with allied health professionals to reduce diagnostic errors
- An investigation into method of diagnosis in clinicopathologic conferences (CPCs)
- Primary care pediatricians’ interest in diagnostic error reduction
- Spurious elevation of serum potassium concentration measured in samples with thrombocytosis
- Mobile phone exposure influences some erythrocytes parameters in vitro. A novel source of preanalytical variability?
- Case Reports
- Those eyes don’t lie: a case of osmotic demyelination syndrome in a patient with hepatic encephalopathy
- CA-125: What does that lab really mean?
- Letter to the Editor
- Assessment of reticulated platelets with automated hemocytometers: are we measuring the same thing?
- Congress Abstracts
- Diagnostic Error in Medicine 1st European Conference June 30–July 1, 2016
