In 2015, major U.S. news organizations flocked to cover a seminal report by the Institute of Medicine that described the widespread harms from missed and delayed diagnoses.
But since that burst of attention, health care providers have done little to address the problem, according to leading researchers in the field who spoke at a conference in the Netherlands this month.
“I think every country is struggling with this,” Laura Zwaan, Ph.D., an assistant professor at the Institute of Medical Education Research at Erasmus Medical Center in Rotterdam, said in an interview.
She and other researchers at the conference, which was conducted by the Society to Improve Diagnosis in Medicine, suggested that journalists ask leaders of their local health care organizations what, if anything, they are doing to reduce diagnostic error.
One of the most important questions journalists can ask is whether health care institutions even see diagnostic errors as a problem, Zwaan said.
The event was sponsored by the Gordon and Betty Moore Foundation, which also funds AHCJ’s patient safety coverage.
Why diagnosis is so hard
One plus for reporters is that many people have a story about a missed or delayed diagnosis that affected them or someone they know. The Institute of Medicine report stated that most people are likely to experience at least one diagnostic error in their lifetime.
Some speakers noted that errors often involve common conditions such as pneumonia, asthma, heart failure and cancer.
Yet news coverage tends to spotlight extraordinary cases, such as a Dallas hospital’s failure to identify a patient with Ebola in 2014 due, in part, to a communication breakdown. Malpractice lawsuits are commonly covered.
Reporting seldom provides context about the frequency, causes and solutions of diagnostic error.
At the conference, researchers stressed that it is a complex problem. With about 10,000 diseases, getting diagnoses consistently right is “harder than rocket science,” SIDM founder Mark Graber, M.D., said in a presentation.
Graber is credited with launching the diagnostic safety movement with a paper published in 2002. He later co-authored a study in 2005 that showed diagnostic error typically involves flaws in both the health care system and clinicians’ cognitive reasoning.
Graber estimated that diagnostic error contributes to about 10 deaths per U.S. hospital per year, yet “only a couple percent” of U.S. hospitals are attempting to fix the problem, he said. He and other speakers noted that physicians are often overconfident in their own abilities.
Reporting on solutions
Research has revealed approaches that can reduce errors.
“We know what needs to be done,” said Hardeep Singh, M.D., M.P.H., co-chief of the Health Policy, Quality and Informatics Program at the Michael E. DeBakey VA Medical Center in Houston.
Here are some themes from the conference that journalists can include their coverage:
- Decision support tools, clinician teamwork, and second opinions are underutilized.
- Individuals with limited language skills, low incomes and low levels of education are disproportionately affected by diagnostic error and need extra support.
- Artificial intelligence might be able to aid in diagnosis, but it requires accurate and complete data in electronic health records, which is often lacking. (Consider the widely reported death of 12-year-old Rory Staunton, whose sepsis was missed because hospital emergency staff didn’t detect dark spots on his skin.)
- Diagnostic reasoning skills aren’t typically part of medical school curricula despite their importance in clinical practice.
- Steps that individual patients can take to prevent errors are another valuable reporting angle, some researchers said. They include checking the accuracy of their own electronic health records, carefully recording their own histories, and asking physicians to explain their diagnostic reasoning.
Creating accountability
Journalists can ask health care executives whether their organizations have taken steps to reduce diagnostic error, Singh and Graber said in an interview.
The Safer Dx Checklist has 10 recommended practices to aid in diagnosis, including creating a team that’s responsible for diagnostic safety, soliciting patient feedback, and ensuring follow-up of abnormal test results.
The Leapfrog Group, a not-for-profit health care industry watchdog, also has a list of 29 actions that hospitals can take to protect patients from diagnostic error. They include holding senior officials accountable for achieving diagnostic safety goals and communicating progress to governing boards.
Leapfrog’s website says it will add questions about diagnostic safety to its voluntary hospital survey next year.
During his presentation, Singh credited the U.S. news media with having “put the topic of diagnostic errors on the map” but added that industry progress is “not enough to tip the scales.” He said he’s lobbying policymakers, industry leaders and accrediting bodies to do more.
Some folks seem to be listening.
Singh said he was encouraged that the U.S. Centers for Medicare & Medicaid Services last year began requiring hospitals to use SAFER Guides, a tool he helped develop to reduce medical errors related to electronic health records.
Congress has increased funding for research, enabling the Agency for Healthcare Research and Quality to award 10 grants to create diagnostic safety centers of excellence.
More changes are in the pipeline. The Centers for Medicare & Medicaid Services has announced that it will begin assessing hospitals on whether they have the infrastructure to support patient safety, and the Biden administration is considering further executive actions on patient safety. Singh said those efforts could help to spur reductions in diagnostic error.
