Improving Diagnosis: Challenges and Opportunities
Improving Diagnosis in Health Care, a new report by the Institute of Medicine, inspired artists at VisualDx to produce the infographic shown below. VisualDx is a widely used web-based clinical tool used to enhance diagnostic accuracy, aid therapeutic decisions, and improve patient safety. Art Papier, MD, co-founder and CEO of VisualDx, is a member of the board of the Society to Improve Diagnosis in Medicine, which petitioned the IOM to produce the report. Papier reflects on the problem of diagnostic error and looks forward to increased improvement efforts:
If we are s
erious about fixing healthcare, we have to recognize core problems and work hard on them. Diagnostic error is one such problem.
While we are enamored with new technology and advances in testing, the clinical diagnostic practice of medicine has changed only slightly. This is due to one simple, immutable fact: there are too many diagnoses, too many symptoms, and too much ambiguity for clinicians to work from memory alone and be diagnostically reliable with every patient.
Whether seen in the office or virtually, patients come to doctors with problems. Back pain, depression, shortness of breath, rash, and headache are just a few of the complaints a primary care clinician will see in a typical day. There are hundreds of complaints, each with multiple potential causes, and the primary care doctor must handle them all. Over 1 billion outpatient visits in the U.S. occur each year, and the recently published IOM report states that at least 5% of these visits will have a diagnostic error.
The IOM report recommends several actions. The drive toward accuracy begins with increased communication both between the doctor and patient and across the entire care team. The IOM also emphasizes the importance of doing a thorough history and physical exam, reducing overreliance on diagnostic testing, and using clinical decision support tools.
There are many steps to take. One immediate action is to recognize that physicians cannot know it all. To curb medical misdiagnosis, our model of what a doctor is, and does, must change. Doctors need to be able to access relevant information at the point of care. The IOM diagnostic errors report forces us to think about augmenting our brains, not with simple computer-based references or reliance on more tests, genetic studies, and x-rays, but with new cognitive systems designed to pull the history and physical exam together to answer questions as we work. New digital systems accessible on smart devices will engage patients and replace the outdated waiting room clipboard screening questionnaires.
Now that the IOM is helping the public realize the extent of the diagnostic errors problem, we can start to invest in new point-of-care information tools as well as new methods to aid thinking, and hopefully diminish the number of patients who are misdiagnosed every year.
Reference:
Balogh, E. P., Miller, B. T., & Ball, J. R. (Eds.). (2015). Improving diagnosis in health care. Washington, DC: National Academies Press. Retrieved from http://www.nap.edu/catalog/21794/improving-diagnosis-in-health-care