Factors in Diagnostic Error
People may assume that diagnostic errors result from sub-optimal care. While this cause is possible, rarely does it explain the problem. Much more commonly, diagnostic error stems from the complexity of the diagnostic process, complexities in how health care is delivered, and the same kinds of cognitive errors that we all make in our everyday lives.
Complexity of the Diagnostic Process
Diagnosis is a very complex process. There are over 10,000 known diseases and 5,000 kinds of laboratory tests, but there is only a small number of symptoms, so that any one symptom may have dozens or hundreds of possible explanations.
Diagnostic testing may be helpful to clarify the problem, but often it is simply a matter of observing the clinical course, which takes time. An error may occur at any step of the process; while getting a complete patient history, doing an appropriately thorough examination, obtaining the right tests, or interpreting tests correctly.
Intricacies in Healthcare Delivery
Healthcare systems link hundreds of different processes, practices, procedures, and technologies to deliver safe and accurate diagnoses. While medical systems are built with patient safety in mind, the complexity of our health care can cause the baton to drop, despite everyone’s best effort.
Many diagnostic errors involve breakdowns in communication and coordinating care, or other problems in our healthcare systems. Test results can get lost, sub-specialty consultation may not be available in a timely manner, or testing equipment may be malfunctioning. Our healthcare systems grow more complicated by the day, and care is delivered in many different settings.
Doctors are human and make the same kinds of mental errors we all make in our every day lives. Sometimes we don’t notice a key finding, or we misinterpret what was said. We may jump to conclusions, or fail to consider whether there might be a better answer than our first idea.
We think we’ve made sense of the situation, but we might be wrong.
For example, although a stomach ailment may be the explanation for a patient’s abdominal pain, the same pain can be mimicked by vascular or neurological conditions that don’t immediately come to mind.
Patient Safety Imperative
Accurate and timely diagnosis are the two cornerstones of high-quality patient care. Harm can result from diseases that aren’t treated at an early stage, or if treatment isn’t appropriate for the condition you have.
Patients can help avoid diagnostic errors by becoming more knowledgeable about the diagnostic process. Engaged patients have the best outcomes. The National Academy of Medicine (NAM) recommends that patients become full partners in their own care, and patients can be an important safety net in catching diagnostic errors before they lead to harm.
Physicians can help avoid diagnostic errors by better understanding the cognitive errors that can commonly occur, and being especially careful navigating their healthcare systems and resources. Stop to think, use decision support resources, be mindful and reflective, and make the patient your partner in the diagnostic process.
Improving the diagnostic process is not only possible, but it also represents a moral, professional, and public health imperative.