“One in Six NHS Patients Misdiagnosed” was the gist of a headline on a couple of papers yesterday. Not a good thing, obviously. But, what is the alternative? Arguments such as this seem to work on an assumption that the alternative is everything working perfectly. This is clearly not the case: a complex process such as medical diagnosis, whilst capable of improvement, is clearly going to have systematic inaccuracies that are not the failings of individual doctors in the system.

In such cases what, seriously, is the proposed alternative? That we give up doing medicine until everything is perfect? I can understand a willingness to make progress, but the assumption that the only reason hard problems are hard is human error seems to be a significant misunderstanding.

The willingness of commentators to assume that the only source of non-perfect performance is human error or lack of skill is evidenced by the
article in the telegraph today, which blames some of these errors on doctors being “too quick to judge patients’ symptoms”. Clearly this an error that is made some of the time, but to prioritise this explanation over the more systematic explanation that diagnosis is difficult seems to misunderstand the situation. (In its favour, the article does move on to talk about keeping a national registry of misdiagnoses, which seems a very sensible plan if the data can be analysed sufficiently well).

Alternative headline: “83% of patients receive correct diagnosis.” Given that we all acknowledge that medicine is difficult, this alternative take seems reasonably positive.