Background: Bronchiolitis is a clinical diagnosis, with growing research supporting limited use of diagnostic tests and interventions. Hospitals have reduced use of bronchodilators and imaging, but the national average of respiratory viral testing (RVT) in these children continues to be high at 33%. Over the past three years, RCHSD’s rate has persisted at 31-35%, despite [...]

Background: The diagnostic process is fraught with diagnostic uncertainty. Typically, discussions about diagnostic uncertainty occur upon admission and during rounds, which are increasingly conducted virtually during the COVID-19 pandemic. Furthermore, key dimensions in the diagnostic process (history taking, physical examination, interpretation of diagnostic tests) are affected by breakdowns in communication between patients and clinicians, physical [...]

Background: Current surveillance approaches underestimate harmful diagnostic errors (DE) in hospitalized patients. A recent study of 2809 admissions observed that while one or more adverse events (AE) occurred in 23.6% of cases, only 10 AEs (0.1%) were attributable to DEs (1). Studies using the Safer Dx instrument have observed harmful DE rates of 5-7% (2). [...]

Background: Preclerkship medical education promotes the concept of clinical certainty through multiple choice testing and diagnostic reasoning curricula focused on System 1 thinking, namely illness scripts and pattern recognition (1). Clerkship medical education reinforces this concept via diagnosis driven didactic sessions and limited physician-led discussions of management uncertainty (2). Yet, clinical uncertainty is an inherent [...]

Background: Diagnostic uncertainty, defined as the subjective perception of an inability to provide an accurate explanation of the patient’s health problem, has been implicated in diagnostic error.1 Clinician notes, such as the admission notes, often include hedging terms, uncertainty phrases, and diagnostic differentials that can be used to assess uncertainty in unstructured documentation.1,2 Quantifying diagnostic [...]

Background: Uncertainty, defined as the “subjective perception of ignorance”(1), is an inescapable and familiar reality to those who practice hospital medicine. An inability to tolerate uncertainty is associated with burnout, anxiety, depression, and inappropriate use of resources (2). Learning more about how hospitalists experience and manage uncertainty will aid us in promoting high-value care by [...]

Case Presentation: The World Health Organization designates a rare disease as one affecting under 6.5-10 per 10,000 people (1). We present a case of disparate findings, ultimately diagnosing Erdheim-Chester Disease (ECD), a rare non-Langerhans histiocytic multisystem disorder with fewer than 1000 reported cases (2,3).A 63-year-old man presented with months of progressively worsening anasarca, acute on [...]

Case Presentation: A 2-year-old male with atopic dermatitis presented with worsening eczema, induration, erythema, and inability to bear weight on his left foot. He was afebrile and had initially been diagnosed with cellulitis. He had been treated with 2 different oral antibiotics and was hospitalized due to presumed failure of oral antibiotics. On admission, the [...]