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What’s the Diagnosis?

diagnosisThe health care industry continues to focus on ways to reduce costs while improving clinical outcomes. In a recent report, researchers discovered that about one in every 10 patient deaths can be attributed, at least in part, to errors in diagnosis. The study revealed that approximately 5 percent of outpatients experience a diagnostic error each year. Furthermore, diagnostic errors account for more medical malpractice claims than any other error, and are nearly twice as likely to lead to patient death as other claims.

The study, which was conducted by the National Academies of Sciences, Engineering and Medicine, defined diagnostic error as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.”

Mistakes in diagnoses can be caused by a wide range of factors, ranging from physician incompetence to poor collaboration and communication with the patient. The lack of transparency and disclosure of diagnostic errors hampers the medical industry’s ability to track, learn from and improve diagnostic efforts.

This particular issue is not likely to improve based on safety measures that have been implemented in the past, and therefore calls for new measures. The report, titled “Improving Diagnosis in Health Care,” made the following recommendations based on a study of current evidence.

Providers should be encouraged to engage in more effective teamwork during the diagnostic process to tap various areas of expertise, levels of experience and provide a checks-and-balances system. This tactic has demonstrated a marked reduction in diagnostic mistakes and also serves to promote clinician confidence in the patient diagnosis. Providers should pursue advanced education and training in new evidence-based guidelines for the diagnostic process, including certification and accreditation programs that test knowledge and competency throughout their career.

Changes should be made with regard to the legal environment in order to facilitate timely identification, disclosure and lessons learned from diagnostic errors.

Health care systems, including hospitals, should adopt communication and resolution programs that encourage doctors and staff to report potential issues without fear of punishment. Health care systems should invest in health information technologies (IT) to support patients and health care professionals in the diagnostic process.

Develop a reporting environment and medical liability system that can disseminate information designed to improve diagnosis rates by sharing others’ diagnostic errors and near misses. This reporting mechanism should be designated as a safe environment for the purpose of learning, without the threat of legal or disciplinary action.

The current fee-for-service payment system appears to contribute to the issue of misdiagnosis. The report recommends the development of a payment model with built-in incentives for providers to collaborate and coordinate patient care to better support the diagnostic process. Provide dedicated funding for research on the diagnostic process and the prevention of diagnostic errors.

  1. The National Academies of Sciences, Engineering and Medicine. September 2015. “Improving Diagnosis in Health Care.”
    http://iom.nationalacademies.org/reports/2015/improving-diagnosis-in-healthcare/~/media/Files/Report%20Files/2015/ImprovingDiagnosis/DiagnosticError_ReportBrief.pdf. Accessed Oct. 7, 2015.