ABSTRACT
C. Heneghan et al. described the diagnostic process as comprising three stages: initiation, refinement and definition of final diagnosis. His group attempted to identify the strategies used in each stage by primary care physicians. Different clinicians used different approaches to the same problem but some general themes emerged. Certain diagnoses can be made clinically; for example, in a reasonably well child with findings consistent with chickenpox, an initial clinical diagnosis can be made without the need for further investigation. In other cases, such as bowel symptoms suggestive of irritable bowel syndrome, must actively rule out a number of other diagnoses such as coeliac disease and cancer before making this diagnosis. The term diagnostic error refers to situations in which a diagnosis is missed, delayed or incorrect. H. Singh et al. emphasise that these situations often overlap within a single case. Research is an emerging field and very challenging in terms of how diagnostic error is defined and measured.
