The gaps in specialists’ diagnoses

Specialists need broad expertise in diagnosing clinical problems arising from diseases involving different organ systems

On average, about 10% of primary care visits result in a referral to a specialist,1 and of these, up to half relate to diagnostic uncertainty.2 Diagnostic error is estimated to occur in between 10% and 15% of clinical encounters.3 Medicolegal concerns loom large around missed or delayed diagnosis of potentially serious conditions such as heart disease or cancer. Patients often present with non-specific symptoms and signs, especially in the early stages of emerging illness, which can be accentuated in the complex context of multiple comorbidities, frailty or other disabilities. Accordingly, a broad differential diagnosis that includes diseases of more than one organ system has to be considered, followed by a recursive refinement of diagnostic probability in the face of uncertainty.