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Palliative medicine and the diagnostic process: who is prematurely closing the door on whom?
  1. Peter Hanlon1 and
  2. Stephen J Fenning2
  1. 1General Practice Vocational Training Scheme, NHS Forth Valley, Larbert, UK
  2. 2Department of Palliative Medicine, Victoria Hospice, Victoria Hospital, Kirkcaldy, UK
  1. Correspondence to Dr Peter Hanlon, General Practice Vocational Training Scheme, Forth Valley Royal Hospital, Stirling Road, Larbert FK5 4WR, UK; peter.hanlon{at}nhs.net

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We read with interest the letter by Chiarulli and Hebert1 presenting a case of premature diagnostic closure in palliative medicine, and agree that more work should be undertaken to understand and minimise the impact of cognitive bias in the delivery of supportive and palliative care. To this we would add two further observations.

As the authors illustrate, the specialty is not devoid of diagnostic challenge and its clinicians cannot, therefore, be ‘immune’ from diagnostic error. Croskerry's comprehensive scoping of the literature on bias and failed heuristics identifies many cognitive dispositions to respond (CDRs) that may lead to diagnostic error and palliative medicine would appear to be as fertile a field as any for some of these CDRs to manifest.2 Chiarulli and Hebert make a strong case around our susceptibility to one …

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