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Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
When Critical Issues in Psychiatry was conceived, there were several sub jects I considered to be of crucial importance in a series devoted to residents and clinicians in psychiatry, as well as to other mental health professionals. Of prominence was the pressing need for an in-depth and scholarly exam ination of the interface between medicine and psychiatry. I had been amazed to find that not a single book, to my mind, adequately addressed the psy chological symptoms and manifestations of both common and rare medical illness. It seemed to me that there was a need for a work which would achieve the following goals: First, it would assist in the differential diagnosis of functional psychiatric symptoms versus symptoms secondary to recog nized or unrecognized medical illness; second, it would elucidate the psy chological symptoms resulting from pharmacologic and other therapeutic interventions in medical illness; and third, it would examine the use of psychopharmacological agents in the presence of medical illness and the drugs used to treat that illness. Dr. Jefferson is Board Certified in both internal medicine and psychiatry, and both Drs. Jefferson and Marshall have extensive clinical experience from their many years of consultation/liaison work in psychiatry. Their experience and expertise have resulted in what I believe to be a monumental contri bution to the literature.
Tuberculosis emerged as an epidemic in the 1600s, began to decline as sanitation improved in the 19th century, and retreated further when effective therapy was developed in the 1950s. TB was virtually forgotten until a recent resurgence in the U.S. and around the worldâ€"ominously, in forms resistant to commonly used medicines. What must the nation do to eliminate TB? The distinguished committee from the Institute of Medicine offers recommendations in the key areas of epidemiology and prevention, diagnosis and treatment, funding and organization of public initiatives, and the U.S. role worldwide. The panel also focuses on how to mobilize policy makers and the public to effective action. The book provides important background on the pathology of tuberculosis, its history and status in the U.S., and the public and private response. The committee explains how the U.S. can act with both self-interest and humanitarianism in addressing the worldwide incidence of TB.
A major focus of the philosophy of medicine and, in general, of the philosophy of science has been the interplay of facts and values. Nowhere is an evaluation of this interplay more important than in the ethics of diagnosis. Traditionally, diagnosis has been understood as an epistemological activity which is concerned with facts and excludes the intrusion of values. The essays in this volume challenge this assumption. Questions of knowledge in diagnosis are intimately related to the concerns with intervention that characterize the applied science of medicine. Broad social and individual goals, as well as diverse ethical frameworks, are shown to condition both the processes and results of diagnosis. This has significant implications for bioethics, implications that have not previously been developed. With this volume, `the ethics of diagnosis' is established as an important branch of bioethics.