Ten Principles for More Conservative, Care-Full Diagnosis
Authors: Gordon D. Schiff, Kurt Kroenke, Bruce L. Lambert, Lisa Sanders, Aziz Sheikh
Journal: Annals of Internal Medicine (2019)

Letters4 June 2019Ten Principles for More Conservative, Care-Full DiagnosisGordon D. Schiff, MD, Kurt Kroenke, MD, Bruce L. Lambert, PhD, Lisa Sanders, MD, and Aziz Sheikh, MDGordon D. Schiff, MDBrigham and Women's Hospital, Harvard Medical School Center for Primary Care, Boston, Massachusetts (G.D.S.)Search for more papers by this author, Kurt Kroenke, MDRegenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana (K.K.)Search for more papers by this author, Bruce L. Lambert, PhDCenter for Communication and Health, Northwestern University, Chicago, Illinois (B.L.L.)Search for more papers by this author, Lisa Sanders, MDYale Medical School, New Haven, Connecticut (L.S.)Search for more papers by this author, and Aziz Sheikh, MDUsher Institute of Population Health, University of Edinburgh, Edinburgh, Scotland (A.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0149 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We are grateful for these comments highlighting different but important aspects of the relevance of our commentary.Ms. Rediger and Dr. Miles describe key intersections between the high prevalence of childhood and adult trauma and clinic and office visits for physical symptoms that lack a clear medical diagnosis. We agree and suggest that diagnostic challenges in caring for patients who have such symptoms perfectly show the point that we make in our introduction: Under- and overdiagnosis are not opposing, competing pitfalls to avoid. They are instead 2 sides of the same coin that must be understood and approached ...References1. Tasca C, Rapetti M, Carta MG, Fadda B. Women and hysteria in the history of mental health. Clin Pract Epidemiol Ment Health. 2012;8:110-9. [PMID: 23115576] doi:10.2174/1745017901208010110 CrossrefMedlineGoogle Scholar2. Murray AM, Toussaint A, Althaus A, Löwe B. The challenge of diagnosing non-specific, functional, and somatoform disorders: a systematic review of barriers to diagnosis in primary care. J Psychosom Res. 2016;80:1-10. [PMID: 26721541] doi:10.1016/j.jpsychores.2015.11.002 CrossrefMedlineGoogle Scholar3. Kroenke K. A practical and evidence-based approach to common symptoms: a narrative review. Ann Intern Med. 2014;161:579-86. [PMID: 25329205]. doi:10.7326/M14-0461 LinkGoogle Scholar4. Sherbino J, Dore KL, Wood TJ, Young ME, Gaissmaier W, Kreuger S, et al. The relationship between response time and diagnostic accuracy. Acad Med. 2012;87:785-91. [PMID: 22534592] doi:10.1097/ACM.0b013e318253acbd CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital, Harvard Medical School Center for Primary Care, Boston, Massachusetts (G.D.S.)Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana (K.K.)Center for Communication and Health, Northwestern University, Chicago, Illinois (B.L.L.)Yale Medical School, New Haven, Connecticut (L.S.)Usher Institute of Population Health, University of Edinburgh, Edinburgh, Scotland (A.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1468. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTen Principles for More Conservative, Care-Full Diagnosis Gordon D. Schiff , Stephen A. Martin , David H. Eidelman , Lynn A. Volk , Elise Ruan , Christine Cassel , William Galanter , Mark Johnson , Annemarie Jutel , Kurt Kroenke , Bruce L. Lambert , Joel Lexchin , Sara Myers , Alexa Miller , Stuart Mushlin , Lisa Sanders , and Aziz Sheikh Ten Principles for More Conservative, Care-Full Diagnosis Katherine Rediger and Bailey Miles Ten Principles for More Conservative, Care-Full Diagnosis Thierry Pelaccia Ten Principles for More Conservative, Care-Full Diagnosis James L. Meisel Metrics Cited byCreating a Learning Health System for Improving Diagnostic Safety: Pragmatic Insights from US Health Care OrganizationsDiagnostic error: incidence, impacts, causes and preventive strategies2019 John M. Eisenberg Patient Safety and Quality Awards: An Interview with Gordon D. SchiffPatient safety pearls 4 June 2019Volume 170, Issue 11Page: 823-824KeywordsDisclosureResearch laboratories ePublished: 4 June 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...