Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

The #1 New York Times–bestselling author’s classic novel of life and death drama inside a major American hospital—“easy to read and hard to stop reading” (Kirkus Reviews). Change is in the air when a new board chairman sets out to modernize and expand Three Counties Hospital in Burlington, Pennsylvania—a once venerable institution whose standards have slipped. Dynamic Dr. Kent O’Donnell, a Harvard Medical School–trained surgeon, accepts the board’s offer to lead and reform the rundown, disorganized hospital because he wants to make his mark on the world. As medical-board president, O’Donnell faces his greatest challenge in Dr. Joe Pearson, Three Counties’ elderly head pathologist. Once an excellent diagnostician, Pearson is now out of touch with the latest research and procedures in laboratory medicine. But if the hospital lets the imperious doctor go, it risks losing an important benefactor’s financial support. Arthur Hailey’s fascinating, dramatic, and scrupulously researched story reveals both the professional, personal, and romantic aspects of an administrator-surgeon’s life, as well as the tragedies and moments of joy that occur every day in a hospital—a place where life often begins and ends.

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

An exposé on Big Pharma and the American healthcare system’s zeal for excessive medical testing, from a nationally recognized expert More screening doesn’t lead to better health—but can turn healthy people into patients. Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening. Drawing on 25 years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with “abnormal” test results have been drastically lowered just when technological advances have allowed us to see more and more “abnormalities,” many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10% of 2,000 healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers. With genetic and prenatal screening now common, patients are being diagnosed not with disease but with “pre-disease” or for being at “high risk” of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.

From the bestselling author of Einstein’s Dreams comes this harrowing tale of one man's struggle to cope in a wired world, even as his own biological wiring short-circuits. As Boston’s Red Line shuttles Bill Chalmers to work one summer morning, something extraordinary happens. Suddenly, he can't remember which stop is his, where he works, or even who he is. The only thing he can remember is his corporate motto: the maximum information in the minimum time. Bill’s memory returns, but a strange numbness afflicts him. As he attempts to find a diagnosis for his deteriorating illness, he descends into a nightmarish tangle of inconclusive results, his company’s manic frenzy, and his family’s disbelief. Ultimately, Bill discovers that he is fighting not just for his body but also for his soul.

The continuing development of sub specialties in pediatrics may be justifiably considered to be progress. Due to this fact, complex syn dromes can be analyzed today in their pathogenesis, are better under stood in their symptomatology, and can be therapeutically controlled. Therapy has reached an unexpectedly high level of effectiveness through this specialization, never dreamed of even a few years ago. No pediatrician can afford to do without it. However, this gain in knowledge inevitably places new burdens on the individual physician because of the confusing diversity of the diseases under consideration. The colleague in private practice who is called upon to treat an acutely ill child is all too likely to have the patient admitted to the hospital without necessity or without the de sired diagnostic insight. The hospital-based physician, confronted with the same situation, tends to rely more on a haphazard utilization of the laboratory facilities or the specialists. Should an illness not present itself strictly according to the textbook, the wide range of biochemical investigations and "tolerance tests" to which the patient is subjected offers the physician, made insecure by the diversity of the diagnostic possibilities, an opportunity for thinking and reading on the problem. Medical literature, however, has reached such enormous proportions that many physicians give up trying to keep abreast of it. Be it for lack of time or some other reason, they may consult pediatric literature only superficially or not at all-to the harm of the sick child.

Thoroughly revised and expanded, the 4th edition offers a practical, objective, evidence-based guide to the medical diagnosis and management of child abuse. Written and edited by a vast array of the world's leading experts on child abuse and neglect, this indispensable resource clearly explains the signs, symptoms, and injuries of the abused child. Features hundreds of photographs and illustrations and a wealth of medical, surgical, radiographic, and laboratory information. New chapters include: Sentinel Injuries Burns Medical Neglect and Obesity Environmental Neglect and Social Determinants of Health Supervisional Neglect/Fatal Neglect Drug-Endangered Children Psychological Abuse Family Violence Human Trafficking and Sexual Exploitation via Electronic Media Reporting Abuse, Managing Uncertainty, and Other Legal Issues Professional Considerations for Those Who Care for the Potentially Abused Child Caring for the Child in Out-of-Home Care Trauma-Informed Care and Treatment Identifying Child Maltreatment Creating Change Through Advocacy