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Premature diagnostic closure in palliative medicine
  1. Paul Chiarulli1 and
  2. Randy S Hebert2
  1. 1Temple University, Philadelphia, Pennsylvania, USA
  2. 2Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Randy S Hebert, Chief Medical Officer Healthcare@Home, Allegheny Health Network, 4800 Friendship Ave, Pittsburgh, PA 15224, USA; rhebert{at}wpahs.org

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Introduction

Rates of diagnostic error among clinicians are estimated to be as high as 10–15%. Diagnostic errors occur for many reasons, but the majority are due to cognitive shortcuts in clinical decision-making. These shortcuts are useful because they allow for efficient practice and usually lead experienced clinicians to a correct diagnosis within minutes. They can nonetheless fail with uncommon disease processes or in atypical presentations.

Premature diagnostic closure, ‘the failure to consider other possibilities once an initial diagnosis has been reached’, is the most insidious and pervasive type of cognitive error.1 There is a large body of literature on this error in family medicine, internal medicine and emergency medicine, as these are the fields with the highest levels of diagnostic uncertainty. Premature diagnostic closure has not previously been described in palliative medicine.

Palliative medicine clinicians are rarely involved in the initial diagnosis of life-limiting illness. Rather, they are usually asked to provide expert symptom management and guidance with patient/family …

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