Reducing Diagnostic Error and Improving Diagnoses
It has been estimated that diagnostic error accounts for an estimated 64,000 deaths annually (Laposata, M., M.D., Ph.D., The National Academy of Medicine Report on Diagnostic Errors: Implications for Laboratory Practice, September, 2015). The same report lists medical error (treatment and diagnostics) as the third leading cause of death in the United States, surpassed only by heart disease and cancer.
The most common misdiagnoses in adults are lung cancer, acute myocardial infarction, colorectal cancer, pulmonary embolism, and acute stroke. In children, the most common misdiagnoses are meningitis, pneumonia, malignant tumor, benign tumor, and appendicitis. Underutilization of laboratory tests can result in these misdiagnoses. (Ibid.)
Part of the problem is the reduced communication between the lab and the ordering doctor. Instead of working as a team, the two are usually isolated from each other, with the lab having scant clinical information and the doctor having minimal training in test selection and interpretation. The report recommends, “Remove the barriers to the creation of diagnostic management teams and pay for the interpretation of laboratory test results similar to payment for anatomic pathology and radiology.” (Ibid.)
Another part of the problem is insufficient explanation to the patient and input from an expert to the doctor. The report observes, “A new system needs to be put into place that allows more time for discussion between the patient and the physician—and the willingness of the physician, when necessary, to have an expert describe a patient’s condition.” And, the report recommends improving health information technology “to bring an expert to every healthcare provider who needs help in diagnostic test selection and result interpretation.” The report further recommends partnering administrators with financial and operational expertise with medical doctors with the goal of making decisions based on the most information rather than cost savings and/or inefficient clinical practices. (Ibid.)
The report addresses the poor training medical students receive in laboratory medicine and recommends initiation of “[a] required course for medical students in the United States to teach the appropriate selection of diagnostic tests and interpretation of test results,” and, “There must be an appropriate number of questions on the licensing board exam on this topic.” (Ibid.)
The report bullet points its goals for reducing diagnostic error and improving diagnoses:
- • Facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families
- • Enhance health care professional education and training in the diagnostic process
- • Ensure that health information technologies support patients and health care professionals in the diagnostic process
- • Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice
- • Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance
- • Develop a reporting environment and medical liability system that facilitates improved diagnosis through learning from diagnostic errors and near misses
- • Design a payment and care delivery environment that supports the diagnostic process
- • Provide dedicated funding for research on the diagnostic process and diagnostic errors (Ibid.