Premature Closure and the Medical Hierarchy

While premature closure may be related to process factors, like inexperienced providers and lack of oversight, it may also be built into the hierarchical structure of medicine. As a patient is evaluated by ascending providers, the amount and nature of information that travels up the hierarchy diminishes. For example, the comprehensive history and physical performed by the intern or medical student is filtered based on the experience of the senior resident, which may be further distilled when presented to the attending physician.