"Preflight Checklists" for diagnosis: a personal experience

As physicians, we take pride in our ability to generate, from memory, a complete differential diagnosis for our patients' presenting symptoms. We expect this of ourselves and our trainees, but we do not do it reliably. Studies have found that the most common cause of diagnostic error is the physician's failure to consider the correct diagnosis as a possibility. Other professionals, like airline pilots and nuclear plant operators, have accepted the fallibility of their memories and have learned how to ensure reliable completion of critical tasks by using checklists. But our culture in medicine glorifies physicians who complete the critical task of diagnosis using their memories and disparages those who cheat by referring to a list. Recent studies have supported the use of checklists in the operating room and intensive care unit, but so far they have not been used to make diagnosis more reliable. This essay explores a possible use for differential-diagnosis checklists by describing the author's experience with them in a primary care clinic.