Missing a diagnosis is, obviously, something both doctors and patients continually want to avoid.

But when it happens, is it completely the doctor’s fault? That’s a question Pauline Chen addresses in a recent column. When it pertains to primary care, it all comes down to followup. She cites a recent study looking at breast cancer diagnoses and found that, “roughly a quarter of patients had experienced process of care lapses,” and, both “doctors and patients contributed equally to the resulting diagnostic failures.”

I previously wrote that follow-up is a huge problem, with a study showing that 7 percent of abnormal test results were never communicated to the patient.  Physician practices need to do better in that respect.

But should patients who intentionally don’t followup, or shun medical advice for ineffectual alternative therapies, be completely blame free?

Internist Saul N. Weingart puts it nicely, saying that, although the responsibility shouldn’t be shared 50-50, “I also don’t think it’s 100-zero. I think there’s a shared responsibility. But given that the patients who fall through the cracks are usually the least resourceful and most vulnerable, there is at least a moral obligation for clinicians and health care systems to provide a robust safety net for these patients.”