Above all, Wachter believes that doctors all too often miss the right diagnosis because they engage in "premature closure," settling on one diagnosis without considering alternatives. They should ask themselves "what else could this be?" or "What is the worst thing that could be going on?" perhaps by imagining that if the patient were to be admitted in the hospital with a different diagnosis a few days later, what would the reason be?
In the end, Wachter says, while our post-IOM focus on systems improvement has been critical, we also need to continue turning out "the really smart doctor: someone who keeps up on the literature, goes home at night scratching his head wondering what this could be, who can make the really tough diagnosis."
He worries that, "unless we specifically value diagnostic excellence, these skills may end up going by the wayside."
"We will look good on that quality and patient safety report card," he says, "but get the diagnosis wrong."