If you’ve read Dr. Lisa Sanders’ “Diagnosis” column in The New York Times Magazine, you know the process of identifying a patient’s problem can be fraught with opportunities for error. You also know diagnosis is rich territory for dramatic storytelling.
For health care journalists, it’s a great time to write about the topic. Errors in diagnosis are receiving new attention because of the recently released Institute of Medicine report “Improving Diagnosis in Health Care.” It’s part of the landmark “Quality Chasm Series” that produced the “To Err is Human” report in 2000 and the “Crossing the Quality Chasm” report in 2001.
The committee writing the report concluded that “most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.” What’s more, the committee said, with increasing complexity of the health care system, diagnostic errors will likely get worse without a dedicated focus on improvement.
The Chicago chapter of the Association of Health Care Journalists heard about the diagnosis improvement movement during its Oct. 13 panel at Columbia College’s journalism school.
“The IOM has introduced a whole new concept, which many of us are still struggling with,” said Paul L. Epner, M.B.A., M.Ed., director of the Society to Improve Diagnosis in Medicine and chair of the new Coalition to Improve Diagnosis. “They said not only does [diagnosis] have to be accurate and timely, but it has to be communicated to the patient in a way they can understand and act on.”
To that end, the IOM has produced resources for patients and families, which includes the advice: “Don’t be afraid to ask ‘What else could this be?’”
Often, however, patients hear a doctor’s working diagnosis as final and definitive, said Karen Cosby, M.D., F.A.C.E.P., senior attending physician for the Department of Emergency Medicine, Cook County Hospital, and an associate professor at Rush University Medical School.
Patients need to realize diagnosis is difficult and complex, she said, and “there’s no way to get through a diagnostic process without a considerable risk of error,” Cosby said.
David M. Liebovitz, M.D., F.A.C.P., chief medical information executive for Northwestern Memorial Healthcare Central Region, called the IOM report “clearly overdue.”
“There are numerous single points of failure in the medical system,” Liebovitz said. Errors occur when a dissonant sound gets lost in the cacophony of information about a patient, he said, and health information technology systems can be designed to better highlight the dissonance.
- IOM spotlights diagnostic errors, continues call to improve patient safety
- Modern Healthcare editorial, “Diagnosing Wisely,” by Merrill Goozner
- “Fumbled Handoffs: One Dropped Ball after Another” by Tejal K. Gandhi, M.D., M.P.H., Annals of Internal Medicine, 2005