Tapping Patient Engagement to Reduce Diagnostic Errors

By Christopher Cheney

Drawing information from patients can help boost understanding of why diagnostic errors happen and reduce the risk of future errors, research published this week says.

Diagnostic errors are a serious patient safety problem, impacting about 12 million adult outpatients each year and causing as many as 17% of adverse events for hospitalized patients.

“Health systems should develop and implement formal programs to collect patients’ experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error,” researchers wrote in an article published today in the journal Health Affairs.

The research features an examination of 184 narratives from patients or family members about diagnostic errors collected in a new database maintained by the Empowered Patient Coalition.

The data provide unique and valuable insight into diagnostic errors, the researchers wrote.

“Patients’ reports of their experiences of diagnostic errors can provide information that traditional measurement mechanisms often fail to capture. Given the absence of diagnosis-specific experiences in most surveys and patient-reported outcomes, the only current way to capture patients’ experiences of diagnostic error is via patient complaints. However, complaints are often viewed as satisfaction matters rather than safety signals,” the researchers wrote.

Pain points

The Empowered Patient Coalition narratives identified four areas where poor clinician-patient relations contributed to diagnostic errors.

• Patient knowledge was ignored in 92 of the narratives. Patients or family members said that clinicians ignored or disregarded reports of clinical indications such as symptoms and changes in patient status.
• Disrespect of patients was considered a possible contributing factor in several diagnostic errors. Clinician disrespect of patients was reported in several forms such as belittling, mocking, and stereotyping.
• Failure to communicate was another theme in the narratives, with clinician failings ranging from ineffective communication styles to refusal to talk with patients and family members. Examples of poor communication included unanswered phone calls and unresponsiveness to questions.
• Manipulation or deception was reported in 15 of the narratives. This behavior fell into two categories: Clinicians using fear to influence care decisions or patients who were misled or misinformed.

Addressing the problem

To help reduce diagnostic errors, the Health Affairs researchers propose five methods to collect patient experience data and encourage better communication between clinicians and patients.

• Creating new requirements for clinicians to conduct lifelong communication training. These requirements could include training to manage patient expectations through discourse.
• Including communication skills, professionalism, and safety knowledge in certification and continuing medical education programs.
• Health systems and providers should encourage patient engagement in safety through active and systematic collection of patient observations of clinician behaviors. These patient engagement efforts should be incorporated in mechanisms that are designed to change clinician behaviors.
• Patient reports identifying clinician behaviors that pose a risk of diagnostic errors should result in interventions to foster patient-centered communication. These reports should be corroborated through the medical record or some other form of independent analysis.
• Hospitals and health systems should include patient reports of diagnostic errors into training and patient safety programs.

A multi-pronged approach is needed to address aberrant clinician behaviors that lead to diagnostic errors, Traber Giardina, PhD, lead author of the Health Affairs research, told HealthLeaders today.

“We recommend health systems use a systematic method to collect patient reports of these types of behaviors. This would allow for these behaviors to be identified and monitored. A safety culture that encourages not just patients but also clinicians and staff to report these behaviors is needed. Additionally, we suggest reforms in medical education that highlight patient safety,” she said.

These efforts require walking a fine, said Giardina, a patient safety researcher at the Michael E. DeBakey VA Medical Center and assistant professor of medicine at Baylor College of Medicine, both in Houston.

“Fostering clinician accountability for the unprofessional behaviors experienced by the patients who reported diagnostic errors is sure to be challenging and will need to be balanced by the need to address pressures on clinicians that lead to burnout, which may even contribute to these behaviors. These at-risk behaviors that compromise patient safety must be addressed though. More policy priority to nurture the patient-physician relationship is long overdue.”