From: Misdiagnosis in occupational and environmental medicine: a scoping review
Typical framework | ||||||
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 | (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. |