In late September, the Institute of Medicine released its landmark report on diagnostic errors. Now, a co-author of that report has shared her thoughts on the study findings.
Kathryn McDonald is executive director of Stanford's Center for Health Policy/Center for Primary Care and Outcomes Research. She is also a member of the committee that authored IOM's "Improving Diagnosis in Health Care" report.
Ultimately, the IOM report highlighted how diagnostic errors have been overlooked in the healthcare industry and how healthcare providers can reduce these hazards.
Recently, Ms. McDonald discussed her thoughts with the Stanford Medicine News Center on the report's findings, as well as her own tips to limit the incidence of this underestimated dilemma, a few of which are highlighted below.
1. The legal systems in place that aim to protect patients also hinder transparency.
"In the aftermath of devastating errors that arise from failures in the diagnostic process and teamwork, many patients want to help make the delivery system safer. Concerns about medical liability prevent clinicians from disclosing medical errors to patients and their families, despite calls from numerous groups that full disclosure is an ethical necessity," said Ms. McDonald. "It is often complex to understand the multiple forces that result in a diagnostic error."
2. More research on diagnostics is necessary to prevent future errors.
There is a "huge gap in methods to identify diagnostic errors and near misses, measure their frequency and severity, and figure out a systematic way to make those involved aware of them," said Ms. McDonald. "As a researcher who has spent most of my life developing patient-safety and quality measures, I know we can do better in this area. At the same time, the challenge is significant. Diagnosis occurs over time and involves varying levels of uncertainty. Real research funding, with an applied focus, is needed."
3. It's crucial to define the phrase "diagnostic error."
"Several previous definitions have arisen to accomplish different purposes — often anticipating the measurement challenge. For example, there is a solid stream of research about 'missed opportunities' and 'triggers' that can be found in a medical record showing that there was a sign that a patient might have a serious condition, but then it wasn't followed up with additional testing in a specific and appropriate time frame. The IOM report's definition built upon previous definitions, but with a clear orientation toward patients and their families," said Ms. McDonald.
4. To improve diagnostic errors, healthcare providers can start by building teamwork.
"I guess if I had to underscore a goal where I am most optimistic that it will make a difference in the short run, I'd point to the teamwork one. There is a growing evidence base that the benefits of teamwork accrue to all members of the team, so this recommendation has the potential to be a win-win for all involved," said Ms. McDonald.
5. It's important to understand the faces behind the statistics on diagnostic errors.
"The video [below] has two patients for whom things went poorly and one who had a first-class diagnostic experience because of excellent teamwork…It is well worth watching the video to understand the human side, and the unique patient perspective on this important issue."
To read the full interview, click here.