One of the nation’s most interesting, patient- and media-friendly medical organizations next week will focus on a topic more relevant than ever during a pandemic. The annual meeting of the Society to Improve Diagnosis in Medicine (SIDM), which starts Monday as a virtual event, will focus on “Transforming Education and Practice to Improve Diagnosis.”
The pandemic has highlighted the need for improving diagnostic accuracy, “from how we determine whether a patient has the virus to how we determine if they don’t ― and the potential diagnostic errors associated with a worldwide pandemic,” said Andrew Olson, M.D., a hospitalist and diagnostic expert at MHealth Fairview Bethesda Hospital in St. Paul, Minn. In March, the facility quickly converted into the state’s first hospital (and one of the few in the nation) dedicated to treating COVID-19 patients.
Accuracy of current PCR, antigen and antibody testing related to COVID-19 is sure to be a covered topic.
Roughly 40,000‐80,000 deaths in U.S. hospitals each year can be attributed to diagnostic error, on a par with the annual death toll from breast cancer or diabetes, according to the National Academy of Sciences Engineering Medicine’s 2015 report. Some 12 million people in the United States are affected annually by diagnostic errors, which likely cause more harm than all other medical errors combined, according to an article in the journal BMJ Quality & Safety.
Since the pandemic hit, the diagnosis of disease has become even more complicated. Patients with symptoms have been delaying physician visits due to fear of being exposed to the coronavirus that causes COVID-19. Even when they do try to go, many practices have either limited hours or closed because of reduced demand or staff safety concerns. That has had an impact on diagnostic accuracy.
“From a practice standpoint, (clinicians) are missing (diseases or conditions) because we think that everybody has COVID,” Olson said. “We are having to address how do you teach (clinicians) to give high quality, safe and accurate diagnoses over platforms in telemedicine, where you have less exposure or a different exposure to patients.”
By being forced to go virtual this year, the 13th annual conference may not offer the same cherished networking opportunities in hallways and after-hours events where I and other journalists can acquire valuable insights. But there is a silver lining.
Reporters will be able to view two or more concurrent sessions because recordings will be available a few hours after their conclusion, enabling journalists to catch all the action. It’s always been frustrating for me at large conferences to sometimes have to strain to decipher what a speaker was saying due to poor acoustics, and then have to power walk between sessions in hopes of being in the right place at the right time for the best quotes.
Perhaps more than many other medical conferences, this three-day forum includes significant input from patients and patient safety advocates and are involved early on in the planning. One of the conference’s regular highlights is its Patient Summit, to be held on Tuesday afternoon. This year the summit will address the interlocking issues of COVID diagnosis and health care disparities, since certain racial and ethnic groups have been disproportionately affected by the disease.
“Our patient summit has evolved over the past few years from communication problems in diagnosis, to specifically women’s issues, to medically unexplained symptoms and the problems of the disabled,” said Helen Haskell, president of the non-profit Mothers Against Medical Error and Consumers Advancing Patient Safety. Haskell is chair of SIDM’s Patient Engagement Committee. Now the summit is addressing “problems facing racial/ethnic and chronic patients in COVID diagnoses and particularly in the diagnosis of ‘long COVID.’ ”
“These problems seem to be the same as the diagnostic problems of earlier difficult-to-diagnose illnesses that are usually considered women’s issues (and often dismissed as such),” she said. “Our concern is: Why?”
Olson said that over the society’s history, much of its leaders’ time and effort was devoted to convincing physicians, policymakers, system leaders and funders that diagnostic error is a real, common occurrence with long-term, lethal and expensive consequences. It’s a problem that has not been fixed.
But while still an under-addressed issue, diagnostic error and its consequences at least are now a focus of federal and philanthropic funding, he said. The federal Agency for Health Care Research and Quality in fiscal 2019 fiscal received $2 million to find solutions that reduce diagnostic errors. And a bipartisan House committee has introduced legislation that would allocate $8 million a year from 2021 to 2025 to study the topic.
SIDM itself now has money to award projects. It’s in the process of doling out $4.5 million in grants from the Gordon and Betty Moore Foundation for research projects that target better diagnosis of such issues as sepsis, cancer and patients presenting in the emergency room. It has approved 17 grants to date.
“And we are now to the point where we at SDIM have gone from trying to shine a light on this problem to finding projects that look to a solution,” he said, with workshops and studies where clinicians can learn “skills that they can apply to their practices.”
Another key focus at the conference is addressing ways to curb racial bias in diagnostic pathways and medical training and increase diversity among medical school educators. For example, Olson said, “dermatology textbooks pretty much have white people in them.” SDIM hopes to change curriculum, “so when (students) are taught a condition, you are taught what it looks like in a person with darker skin. We know that health care institutions and medical schools are pretty white places.”
It’s also important to change the makeup of health care providers, so “there’s a good chance that your doctor looks like you,” he added.
Another topic is a growing effort to find evidence-based ways to ensure clinicians are competent to practice as they age or as they move to different specialty areas, Olson said.
For information about the conference and how to register, contact: Lorie Slass, vice president of communications and marketing at the Society to Improve Diagnosis in Medicine, Lorie.Slass@ImproveDiagnosis.org or 215-801-4057.
Here is some earlier coverage of the diagnostic error issue on the AHCJ website: