Patient Engagement, Diagnostics

IOM: Patients hold key to reducing diagnostic error

Two things were missing from previous attempts by the Institute of Medicine to shine light on the epidemic of medical harm in U.S. healthcare: diagnostic error and a patient-centered approach to fixing the many problems.

Two things were missing from previous attempts by the Institute of Medicine to shine light on the epidemic of medical harm in U.S. healthcare: diagnostic error and a patient-centered approach to fixing the many problems. Those are central themes in “Diagnostic Error in Health Care,” the latest installment of the IOM’s Quality Chasm series, released Tuesday.

According to the committee that prepared the new, potentially landmark report, diagnostic error is so prevalent in medicine that the majority of Americans will be victim to at least one “meaningful” diagnostic error in their lifetimes, either due to a delayed or inaccurate diagnosis.

“Perhaps the most important contribution in this report is to highlight the importance of this issue and to direct discussion among patients and healthcare professionals and organizations of what might be done about it,” Dr. John Ball, chair of the IOM Committee on Diagnostic Error in Medicine, said in a news conference that was webcast from Washington Wednesday morning.

The committee actually identified three key themes for the report: Not enough attention has been paid to diagnosis error; patients must work with clinicians to remedy the problem; and diagnosis is a team sport.

“Patients are central to the solution,” Ball said. Same for the team approach. “The stereotype of a single physician contemplating a patient’s presentation and discerning the diagnosis is not always true,” he added.

Ball also said that health IT often is a “barrier to effective clinical care in its current form.”

The report made eight recommendations to address diagnostic error in medicine. Some involve applying technology like clinical decision support, though most address the paternalistic culture of medicine that has persisted for centuries.

“Physicians need to be open to feedback from their colleagues, from other physicians,” said committee member Dr. Christine Cassel, president and CEO of the National Quality Forum. They also need to learn to listen to patients, as this video shown during the presentation suggested.

Indeed, the first patient in this video shares a story similar to what Dr. Carol Gunn related about her sister, with the obvious difference being that this patient survived to tell about it.

One thing the IOM committee did not call for is mandatory reporting of diagnostic errors, including the kinds of delayed diagnoses Gunn talked about. Committee members said that “time was not right for that” because there had been no agreed-upon definition of diagnostic error prior to this report, there isn’t enough data on diagnostic error and it is hard to measure outcomes to collect such data.

“Improving Diagnosis” is the fourth in the Quality Chasm series, which also includes the seminal “To Err is Human: Building a Safer Health System” (1999), “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001) and the lesser-known but equally important “Preventing Medication Errors” (2007).