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Table 1 Typical framework and causation model for misdiagnoses of OD and ED

From: Misdiagnosis in occupational and environmental medicine: a scoping review

Typical framework

 

(i) Evidence of a disease

(ii) Evidence of hazardous exposures

(iii) Evidence of causal relationship

Proper work

Looking for any evidence of a disease in a subpopulation (workplace or community)

Extensively searching for the evidence of possible hazardous exposures in the workplace or community in which patients developed

Based on so-far known medical and public health knowledge, calculate the probability of causation

Flaw

Shortage in knowledge about possible occupational and environmental diseases

Misidentification of a disease

Shortage in knowledge about hazardous occupational or environmental exposures

Shortage of information about exact exposure status of a patient

Shortage in knowledge about the causal relationship between a hazardous exposure and a disease outcome

Consequences

Missed diagnosis

OD or ED diagnosed as another general medical disease

OD or ED diagnosed as another general medical disease

Sometimes the diagnosis itself could be denied.

OD or ED diagnosed as another general medical disease

The estimated probability of causation below 50%: no acknowledgment of an OD or ED

Causation model

 

(i) Knowledge base

(ii) Heuristics

(iii) Complete work-ups

(iv) Diagnosis

(v) Management

(vi) Feedback

Proper work

The first case in a similar exposure group should be examined meticulously with the generation of the knowledge base.

The proper context should be generated based on recognized findings.

Complete work-ups should be done for the consideration of sufficient differential diagnoses.

A valid synthesis should be carried out.

Appropriate treatments and preventive measures should be given.

Appropriate feedback should be given to diagnosis and management.

Flaw

Shortage in knowledge Base

Faulty heuristics

Immature closure

Faulty synthesis

Bad management

No policy or social system for feedback

 Consequences

The OD or ED diagnosis for a similar exposure group cannot be made.

An initial diagnosis will be incorrect

An important differential diagnosis cannot be included.

The final tentative diagnosis will be incorrect.

The treatment and preventive measures will fail

Proper feedbacks on diagnostic processes and a trial of other management options cannot be made.