Sidetracks in the Diagnosis of Gastrointestinal Disease

Sonnenberg, Amnon
November 2000
American Journal of Gastroenterology;Nov2000, Vol. 95 Issue 11, p3039
Academic Journal
Patients usually visit a physician for a particular reason, which medicine has termed the "chief complaint." As patients often have more than a single complaint, it is common for physicians to lose focus, get distracted, and venture down a path other than the one toward resolution of the chief complaint--in other words, to get sidetracked. The aim of the present review is to describe the nature of diagnostic sidetracking, why it occurs, mechanisms in action, and means to prevent it. During a regular diagnostic process, the physician's suspicions about a diagnosis advance from broad and general to narrow and specific concepts. Each step in the diagnostic process is potentially driven by its own hypothesis, and each individual hypothesis becomes verified or falsified by pointed questions during the history or by medical tests. If a diagnostic process were to focus on the correct diagnosis that eventually explained the chief complaint, the intersections among the consecutively refined diagnostic concepts would converge toward one specific set, with the final diagnosis located inside the nonzero intersection of all consecutive diagnostic concepts. In a faulty diagnostic process, consecutive diagnostic concepts fail to converge, and the final diagnosis and chief complaint do not intersect. In this regard, the physician has pursued a false path and has become sidetracked. The effects of sidetracking range from minimal to disastrous. Sidetracking can delay diagnosis, delay treatment, and waste resources investigating or treating irrelevant medical problems. To avoid sidetracking, physicians should focus on the main problem, avoid getting involved with complementary solutions to secondary medical problems, and verify repetitively during the diagnostic process the relationship between each current working hypothesis and the patient's major medical problem.


Related Articles

  • 'Secret club' really one of no one at all. Phipps, Gaeline // New Zealand Doctor;8/15/2012, p25 

    The author comments on two issues affecting doctors in New Zealand. One is the need for a meaningful disclosure of complications or complaint numbers to patients, which was highlighted in the July 9, 2012 edition of current affairs program "Up Close." Another is the barriers facing doctors...

  • Query. Ursus // CMAJ: Canadian Medical Association Journal;7/19/2005, Vol. 173 Issue 2, p218 

    Presents a narrative of the author's experience as a walk-in physician in favor of a colleague who had a family emergency. Manifestations that walk-ins exemplified the worst aspect of medicine; Common complaints encountered as a walk-in physician; Comparison to his normal medical practice.

  • Education: A registrar survival guide - Dealing with complaints. Poduval, Shoba // GP: General Practitioner;6/24/2011, p43 

    The article offers some tips to develop a constructive approach to deal with the problem of patients' complaint in Great Britain. It has been advised to talk with medical defence union, which provides trained medico-legal advisers 24 hours a day. It has been stated that medico-legal advisers...

  • What to do when patients complain. Johnson, Lee J. // Medical Economics;3/21/2008, Vol. 85 Issue 6, p17 

    The article offers information on how to deal with a patient's complaint. Patients will come in a variety of ways to air their grievances. It is important that doctors or physicians will not just listen but should also comprehend every detail of the problem. However, certain medical errors...

  • Why patients should complain. Patel, Kinesh // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;10/23/2010, Vol. 341 Issue 7778, p894 

    The author emphasizes the need for patients to write about their complaints regarding the medical care that they have received.

  • The Doctor Will Mistreat You Now. Atkinson, Jim // Texas Monthly;Sep2005, Vol. 33 Issue 9, p112 

    Offers advice for patients on preventing and dealing with medical errors in Texas. Decision to seek the opinion of other physicians after a diagnosis; Assistance that can be offered by JCAHO.ORG, a body being run by the Joint Commission on Accreditation of Healthcare Organizations, in searching...

  • Handle patient complaints about GPs with care.  // GP: General Practitioner;2/20/2009, p24 

    The article focuses on dealing patient complaints with care concerning general practitioners. According to the article, physicians hope that the Primary Care Trust (PCT) involved will handle with the complaint even-handedly. Physicians also hope that proper systems are in place to assure that...

  • GP Practice: How can I handle an informal complaint? Indrasenan, Natheera // GP: General Practitioner;6/1/2005, p40 

    The article focuses on methods for handling informal complaints related to general practice. If a medical personnel is faced with a patient who is angry at him or her, or with the whole surgery, the physician must start by sitting back and switching off any internal dialogue with the patient....

  • What's Wrong With Today's Doctors? Goldberg, Billy; Leyner, Mark // Best Life;Dec2007/Jan2008, Vol. 4 Issue 10, p90 

    The authors discuss the problems experienced by patients with physicians in the U.S. Patients complain about a physician who does not talk to his patients, and does not make house calls. The authors discuss the proliferation of physicians with television programs and physicians who are...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics