Doctor Missed Diagnosis Reflection: Kolb

Concrete experience

I assessed a middle-aged patient presenting with fatigue and non-specific abdominal discomfort. Their symptoms fitted a common, benign explanation that matched a pattern I had seen repeatedly that month, and initial basic tests were unremarkable. I reassured the patient and arranged routine follow-up. Several weeks later the patient re-presented with progressive symptoms and was subsequently diagnosed with a significant condition that, in retrospect, could have been investigated at the first visit. The eventual outcome was managed appropriately, and the case was reviewed through our governance process.

Reflective observation

Revisiting my notes, the uncomfortable finding was that the information pointing away from the benign explanation was available at the first consultation - I had documented a feature that did not quite fit, and then explained it away. I remember feeling confident, and that the clinic was running late. My reassurance to the patient was genuine, but my safety-netting was generic: I did not name the specific symptoms that should prompt earlier return, and the patient later said they had delayed coming back because they had been told it was nothing serious.

Abstract conceptualisation

This maps closely onto what the diagnostic error literature calls anchoring and premature closure: settling early on a pattern-matched diagnosis and discounting disconfirming evidence. Two general principles emerged for me. First, the feature that 'does not quite fit' deserves the most attention precisely when I feel most confident - confidence is a signal to check, not a licence to close. Second, safety-netting is a diagnostic tool, not a farewell formula: specific, named triggers for return convert an uncertain diagnosis into a monitored one.

Active experimentation

I have changed my practice in three ways and am deliberately monitoring them. I now document a brief 'what else could this be?' line in every assessment where I offer reassurance, forcing a conscious differential check. My safety-netting is specific: named symptoms, named timeframe, and a check that the patient can repeat it back. And I discussed the case (anonymised) at our team's learning meeting, focusing on the cognitive pattern rather than the individual, which several colleagues said mirrored near misses of their own. I will review a sample of my own reassurance consultations in three months to see whether the documentation habit has held.