The hazards of diagnosis.

BACKGROUND: Making a diagnosis is perceived as a climax of clinical effort. Little consideration is being given to potential down sides after the diagnosis is achieved. METHODS: The authors' personal experience, extensive discussions with peers and a search of the literature. RESULTS: Several common and significant pitfalls after making a diagnosis were identified. They include 'locking' and disregard of further data pointing to possible diagnostic error; pursuing a diagnosis when further information has little practical significance; a severe impact of the news on the patient; a 'stigma' effect; loss of the patient's individual narrative; stopping the diagnosis short of the full pathogenesis or of its finer characterization; disregarding additional medical issues; losing interest in the patients once the diagnostic problem is solved; and assuming full control of future decisions at the expense of the patient's autonomy. CONCLUSION: Physicians need to be cognizant of the impact and significant potential for harm associated with closure of diagnosis and its delivery to their patient. Humility, double-checking and sensitivity to the patient's predicament may improve quality and communication and prevent 'the hazards of diagnosis'.

[Method of evaluating the acoustic properties of devices for auscultation]. / Metodika otsenki akusticheskikh svoistv priborov dlia auskul'tatsii

It is suggested that the appraisal of acoustic properties of auscultation instruments should be done by an expert-physician by following the most outstanding auscultative characteristics. A procedure for medical appraisal of acoustic properties is proposed. The BF-1 sthetophonendoscope manufactured by the Nizhny-Tagil medical instruments plant is recommended to serve as a model one.