Safety programs in general practice should focus on prognosis instead of diagnosis

Sunday, December 4th, 2011

Recently, we sent a comment to the editor of Annals of Family Medicine as we do not agree with the ‘lessons for patient safety’ Van Gaal et al stated after studying complaints against family physicians submitted to disciplinary tribunals in the Netherlands. See Track Comments on

The authors concluded that safety programs in family practice should pay more attention to establishing right diagnoses.But we believe that uncertainty and unpredictability are common in family practice and that family physicians may sometimes not yet be able to establish a diagnosis but still have to decide to intervene or to wait and watch. In family practice, a right prognosis about the course of a disease is much more important than establishing a right diagnosis.Taking time to listen, careful examination, awareness of cognitive errors such as anchoring with confirmation bias and premature closure, and taking one’s gut feelings seriously are more fruitful ways to prevent serious errors than establishing the right diagnosis.In our view, research in family practice should particularly identify which signs and symptoms are reliable indicators of the course of a disease, instead of focussing on establishing the diagnosis.