{"id":1321,"date":"2016-07-05T22:00:26","date_gmt":"2016-07-05T21:00:26","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/adc\/?p=1321"},"modified":"2016-07-05T22:00:26","modified_gmt":"2016-07-05T21:00:26","slug":"does-fear-of-missing-a-diagnosis-drive-your-every-action","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/adc\/2016\/07\/05\/does-fear-of-missing-a-diagnosis-drive-your-every-action\/","title":{"rendered":"Does fear of missing a diagnosis drive your every action?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-1306\" src=\"https:\/\/stg-blogs.bmj.com\/adc\/files\/2016\/05\/download-3-150x150.jpg\" alt=\"download (3)\" width=\"150\" height=\"150\" \/>If there was a chance that you missed a diagnosis about which you would be able to intervene 2:1,000 times, and that the test which could diagnose it cost about \u00a33 and was minimally invasive &#8211; wouldn&#8217;t you be daft not to use it?<\/p>\n<p>Or would you think &#8220;what a waste of time!&#8221; and wonder about the \u00a33,000 you had spent to make \u00a36 of a diagnosis?<\/p>\n<p>The dilemma is common &#8211; there are a whole list of things that are traditionally associated with a differential diagnosis which may be exceptionally rare and sometimes coincidental rather than causative.<\/p>\n<p>Take urinary tract infection in jaundiced babies.<\/p>\n<p><!--more--><\/p>\n<p>A <a href=\"http:\/\/adc.bmj.com\/content\/101\/7\/614.short?\">group of enterprising trainee docs in the UK<\/a> took it upon themselves to dive deep into the literature and undertake a systematic review and meta-analysis to see how often a UTI really was related to neonatal jaundice. (It&#8217;s something I recall being a &#8216;must check&#8217; from the dark ages of pre-millennial paeds.)<\/p>\n<p>They tracked down 18 papers and battered them into geographically distinct groups to show between 8 and 0.2% of infants with jaundice had a &#8216;UTI&#8217; &#8212; though the criteria were not always the clearest for diagnosing infection.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter\" src=\"http:\/\/adc.bmj.com\/content\/101\/7\/614\/F3.large.jpg\" width=\"846\" height=\"606\" \/><\/p>\n<p>Now this doesn&#8217;t immediately tell you what you should do &#8211; 0.2% is not a decision but a piece of information &#8211; but it does give you a very solid start on a conversation about what needs to be balanced when looking after this group of infants.<\/p>\n<p>And before you worry just about the UTI you &#8216;miss&#8217;, also think about the harm (potentially physical and psychological) of those you incorrectly diagnose with a UTI and investigate enthusiastically for non-existent renal problems too&#8230;<\/p>\n<p>(For those who want to be part of an enthusiastic bunch like this, I&#8217;m sure they&#8217;ll be happy to hear from you and tell you the real experience of dealing the the ogre-like Journal they published in.)<\/p>\n<ul>\n<li>Bob Phillips<\/li>\n<\/ul>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>If there was a chance that you missed a diagnosis about which you would be able to intervene 2:1,000 times, and that the test which could diagnose it cost about \u00a33 and was minimally invasive &#8211; wouldn&#8217;t you be daft not to use it? Or would you think &#8220;what a waste of time!&#8221; and wonder [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2016\/07\/05\/does-fear-of-missing-a-diagnosis-drive-your-every-action\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[79],"tags":[],"class_list":["post-1321","post","type-post","status-publish","format-standard","hentry","category-archimedes"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/1321","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/comments?post=1321"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/1321\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/media?parent=1321"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/categories?post=1321"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/tags?post=1321"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}