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Patient Involvement Key to Improving Diagnostic Care, Reducing Errors, says IOM

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October 8, 2015

Most people will experience at least one diagnostic error during their lifetime, sometimes with devastating consequences, according to a new report from the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine. Diagnostic errors are defined as inaccurate or delayed diagnoses. Though data on the problem is lacking, it is estimated that these errors may account for up to 17% of adverse events in hospitals and as many as 10% of all hospital deaths.

In order to improve diagnoses and reduce errors, the IOM report offers some critical recommendations, including more effective teamwork among healthcare professionals, patients, and their families.

"Diagnosis is a collective effort that often involves a team of health care professionals -- from primary care physicians, to nurses, to pathologists and radiologists," said John R. Ball, chair of the IOM committee that wrote the new report and executive vice president emeritus, American College of Physicians. "The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error. Therefore, to make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis [is] made."

A major issue cited by the report as contributing to the problem is a lack of feedback to clinicians from patients, family members and other physicians about the accuracy of a diagnosis. Greater involvement of patients and their families in the process is important "because they contribute valuable input that informs diagnosis and decisions about their care."

Healthcare organizations and health professionals need to provide patients with opportunities to learn about the steps involved in making a diagnosis and should make sure patients have access to their electronic health records, including clinical notes and test results. It is important to "create environments in which patients and families are comfortable engaging in the diagnostic process and sharing feedback and concerns about possible diagnostic errors," says the IOM.

The report includes resources for patients and their families to encourage participation and help them communicate more effectively with their providers, with the ultimate goal of getting to the correct diagnosis. There are checklists with ideas on how to give a complete medical history and describe a medical problem more clearly as well as guidance on keeping good personal medical records, to name a few examples. The lists also advise patients to follow up with health practitioners during the diagnostic process and ask their healthcare providers to think about other potential explanations for an illness.

Laboratory testing is often a key component of the diagnostic process. The IOM offers specific guidance to patients and their families on testing:

  • Ask when you can expect the results of your tests.
  • Make sure both you and your healthcare provider get the results from any tests that are done.
  • Don't assume that no news is good news; call and check on your test results.
  • If you have more than one healthcare provider, make sure each one knows your test results.
  • After getting the results, ask what they mean and what needs to be done next.

In a statement released following the publication of the IOM report, the American Association for Clinical Chemistry (AACC), producer of Lab Tests Online, said "one…of the most powerful recommendations for reducing these errors—and one that deserves more prominence—is the call to improve how doctors and nurses work with the healthcare professionals who run diagnostic testing in the lab."

Recognizing the importance of teamwork and patient communication in improving diagnostic care, AACC produces Lab Tests Online in cooperation with 16 other laboratory professional societies. The site aims to help patients and their families learn more about their lab tests and make conversations with their healthcare providers about testing easier. (To read about a test, find the name in the pull down menu on the homepage or type the name of the test in the search box.)

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

(September 22, 2015.) Urgent Change Needed to Improve Diagnosis in Health Care or Diagnostic Errors Will Likely Worsen, Says New Report. The National Academies of Sciences, Engineering, Medicine. Available online at http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=21794. Accessed September 29, 2015.

Improving Diagnosis in Health Care (2015). The National Academies of Sciences, Engineering, Medicine, Recommendations. Available online at http://iom.nationalacademies.org/reports/2015/improving-diagnosis-in-healthcare/~/media/Files/Report%20Files/2015/Improving-Diagnosis/Diagnosis_Recommendations.pdf. Accessed September 29, 2015.

(September 22, 2015.) AACC Welcomes Enhanced Role for Laboratory Medicine Experts to Combat Potentially Devastating Diagnostic Error. American Association for Clinical Chemistry. Available online at https://www.aacc.org/media/press-release-archive/2015/report-calls-for-increased-role-for-laboratory-medicine-experts-to-combat-diagnostic-error. Accessed September 29, 2015.

Sternberg, Steve. Countless Patients Harmed by Wrong or Delayed Diagnoses. US News and World Report. September 22, 2015. Available online at http://www.usnews.com/news/articles/2015/09/22/iom-study-shows-errors-in-diagnosis-harm-countless-patients-each-year. Accessed September 29, 2015.