Evelyn Vargas was told, in three separate settings over fourteen months, that what she was feeling was anxiety. She did have anxiety. That was the clever part of it.
The practice runs a flag on anyone presenting three times with the same complaint and no diagnosis, regardless of what was concluded each time.
The third appointment
Continuity was measured for a year: what proportion of appointments a patient had with the clinician who knew them. It had fallen to under a third.
One appointment being wrong is medicine. Three appointments reaching the same wrong conclusion is a system problem.
Dr. Yusuf Marchetti, cardiology
The referral that worked
Nothing about the individual consultations was careless. Every clinician was working correctly from what was in front of them; nobody’s job was to look at the shape of the whole thing.
“Now something’s job is to look at the whole shape of it,” she says. “That’s the change.”
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