I am fascinated with how we, as medical professionals, approach clinical diagnosis.
My interest began with years of being a Quality Assurance director for my department at my local hospital. I reviewed cases and then branched out into reviewing medico-legal cases for defense attorneys. In reading through medical records (often with the hindsight of the outcome), the idea of how we arrive (or miss) diagnoses or a clinical picture became deeply riveting.
There is literature on the topic, to be sure. Lots of publications, chapters in textbooks, about the optimal way to approach diagnosis. They all seemed better suited to the classroom, due to the time required for the process.
I also found numerous articles about cognitive bias, heuristics,etc. many of which were written by authors who had never set foot in a clinic or hospital. No offense, but if haven’t played the game, I don’t expect you to provide commentary. And I certainly would not take you on as a coach.
My thought was to write a book, but I found that there were just too many approaches to the process of clinical diagnosis. And there is no overarching principle that works for each person.
The concept of “metacognition” , the awareness and understanding of one’s own thought processes, has come the closest to expressing what I believe we need in the medical arts. As a result, I decided to start this site. I hope to write posts and share stories that will assist all of us in becoming better for ourselves and those in our care. There is no judgement here. I freely admit that the mountains of mistakes I have made are in no small part the fuel to this fire.
Lastly, I dedicate this site to my parents, Dr Tiruvan Nagendran and Dr. Somadevi S. Nagendran. My dad was a consummate educator and surgeon, who worked tirelessly to care for our nation’s veterans. He remains in my heart as my comfort and the best clinician I have ever known. My mom is still missed by our hospital as the best pathologist who ever worked within its walls, as well as being their first female physician.