Getting the right diagnosis is a key aspect of health care — it provides an explanation of a patient’s health problem and informs subsequent health care decisions. A new report published this month by the Institute of Medicine, Improving Diagnosis in Health Care, is a a continuation of the landmark Institute of Medicine reports To Err is Human: Building a Safer Health System (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001) finds that diagnosis — and, in particular, the occurrence of diagnostic errors — has been largely unappreciated in efforts to improve the quality and safety of health care. The result of this inattention is significant: the committee concluded that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.
According to the report, diagnostic errors cause about 10 percent of patient deaths. Studies of patient medical records also suggest that 6 percent to 17 percent of “adverse events,” or harms that occur to patients during a hospital stay, resulted from diagnostic errors. And in the current hospital culture, many doctors are not aware of the errors they make. “Diagnostic errors persist throughout all settings of care and continue to harm an unacceptable number of patients.”
The report says that diagnostic errors stem from many causes, including inadequate collaboration and communication among clinicians, patients, and their families; a health care work system that is not well designed to support the diagnostic process; limited feedback to clinicians about diagnostic performance; and a culture that discourages transparency and disclosure of diagnostic errors, which in turn may impede attempts to learn from these events and improve diagnosis.
Collecting such data is challenging because many healthcare settings discourage the disclosure of diagnostic errors, the report said. To address such problems, the committee concluded that improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The committee’s recommendations contribute to the growing momentum for change in this crucial area of health care quality and safety.