Those other questions...

Throughout our medical training we are told again and again that the most important task is an accurate diagnosis. And we hear it at CME lectures and read it in journals. An accurate diagnosis is certainly essential if one wants to offer successful and safe treatment.  But it is not enough to ask and answer: “What is the diagnosis?”

There are several other questions that every experienced clinician asks - and answers - with every visit. Or should ask. We skip these questions at considerable risk to our patients.

• How sure am I of the diagnosis? 
• What data have I discarded or discounted to be this sure? (The question is not whether or not one has discarded information, it is how much and how appropriately.)
• How will I know my diagnosis is right?
• What else could it be? (What is Plan B? Plan C? Plan…X?)
• Do I need to actively consider other choices now, or can I wait?
• What do I look for to alert me that I am wrong? (This is not the same questions as how will I know I am right? Framing is important. If I am only looking for confirmation, I will only find confirmation.)

If you are a clinician – make sure you are asking yourself these questions. It may save your patient’s life. If you are a patient – ask your clinician these questions. It may save your life.