Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
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Holland M. Kaplan
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Jacqueline F. Birnbaum
Abstract
Premature closure is often described as a significant contributor to diagnostic error. Therefore, developing strategies to mitigate premature closure could reduce diagnostic errors and improve patient care. Here we propose the novel concept of pursuit of an “endpoint diagnosis” as a cognitive forcing strategy (CFS) for avoiding premature diagnostic closure. We define an “endpoint diagnosis” as an underlying causative explanation for a patient’s signs, symptoms, and laboratory and radiographic data that exhausts additional relevant diagnostic evaluation. We have observed four contexts in which the error of not pursuing an endpoint diagnosis most often occurs: (1) diagnoses that appear to result in the same treatment regardless of etiology, (2) cases that are particularly complex, (3) clinical scenarios that are vulnerable to systems errors, and (4) situations in which patients’ problems are attributed to uncontrolled underlying risk factors or an exacerbation of a known condition. Additionally, we address why we believe endpoint diagnoses are not universally pursued, delineate when this approach might be particularly useful, attempt to reconcile the potential conflict between accepting diagnostic ambiguity in certain instances and pursuing endpoint diagnoses, and outline possible concerns that might arise with using this CFS, including the possibility of lengthy evaluations resulting in overdiagnosis and overtreatment. Our overarching goal is for this CFS to help clinicians in their daily clinical practice as they seek to optimize their diagnostic skill and patient care.
Acknowledgments
We would like to thank Dr. Gurpreet Dhaliwal for his thoughtful feedback on our manuscript.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: Not applicable.
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© 2022 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review
- Diagnostic and therapeutic approach to hypernatremia
- Opinion Papers
- The diagnostic potential and barriers of microbiome based therapeutics
- Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
- Guidelines and Recommendations
- The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
- Original Articles
- Exploring procedure-based management reasoning: a case of tension pneumothorax
- A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts
- Human centered design workshops as a meta-solution to diagnostic disparities
- Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum
- Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning
- Evolution of throat symptoms during the COVID-19 pandemic in the US
- Evaluating the role of a fully automated SARS-CoV-2 antigen ECLIA immunoassay in the management of the SARS COV 2 pandemic on general population
- miR-21-3p and miR-192-5p in patients with type 2 diabetic nephropathy
- Letter to the Editors
- Convoluted molecular maze of neprilysin
- OPeNet: an AI-based platform implemented to facilitate clinical reasoning by primary care practitioners, as well as the virtuous co-management of chronic patients during and after the COVID-19 pandemic in Italy
- Letter to the Editor in reply to Diamandis “COVID-19 and the Le Chatelier’s principle”
Artikel in diesem Heft
- Frontmatter
- Review
- Diagnostic and therapeutic approach to hypernatremia
- Opinion Papers
- The diagnostic potential and barriers of microbiome based therapeutics
- Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
- Guidelines and Recommendations
- The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
- Original Articles
- Exploring procedure-based management reasoning: a case of tension pneumothorax
- A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts
- Human centered design workshops as a meta-solution to diagnostic disparities
- Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum
- Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning
- Evolution of throat symptoms during the COVID-19 pandemic in the US
- Evaluating the role of a fully automated SARS-CoV-2 antigen ECLIA immunoassay in the management of the SARS COV 2 pandemic on general population
- miR-21-3p and miR-192-5p in patients with type 2 diabetic nephropathy
- Letter to the Editors
- Convoluted molecular maze of neprilysin
- OPeNet: an AI-based platform implemented to facilitate clinical reasoning by primary care practitioners, as well as the virtuous co-management of chronic patients during and after the COVID-19 pandemic in Italy
- Letter to the Editor in reply to Diamandis “COVID-19 and the Le Chatelier’s principle”
