Try Teamwork to Avoid a Missed Diagnosis

A recent blog in ModernHealthcare.com reported that 1 in 20 U.S. adults might be misdiagnosed during an outpatient visit, and that about half of those errors eventually could cause harm. About 12 million U.S. adults experience a diagnostic mistake every year. Are they lapses in judgment? The result of rushed appointments? An inability to communicate?

You’d think after so many reports of such widespread medical error that researchers would have made a lot of progress scaling the learning curve of misdiagnosis.

A recent article in the Journal of the American Medical Association (JAMA) concluded that teamwork might be one approach to reducing the incidence of diagnostic error, a condition that’s missed, delayed or diagnosed incorrectly.

“When two doctors worked together,” summarized Modern Healthcare “their confidence in a diagnosis was boosted and their determination was more accurate.”

The study subjects were 88 fourth-year medical student volunteers. They were shown video of simulated patient cases, then asked to quickly determine which of 30 diagnostic tests should be ordered, and to select one of 20 possible diagnoses from a list. They also rated on a scale of 1 (least confident) to 10 (most confident) how certain they were of their conclusions.

Twenty-eight of the students worked individually and the rest worked in pairs.

The pairs took 2:02 minutes longer than individuals to make decisions, but they were more accurate in selecting a diagnosis (68 %) compared with the solo subjects (50%). And pairs expressed more confidence in their decision than the singles.

The sample was quite small, of course, and no broad or significant conclusions could be drawn from the exercise. But the results point the way toward more fruitful, definitive examinations.

“Neither differences in knowledge nor in amount and relevance of acquired information explained the superior accuracy of the pairs,” the authors wrote. “Collaboration may have helped correct errors, fill knowledge gaps and counteract reasoning flaws.”

As JAMA noted, the patient safety community is anticipating an Institute of Medicine (IOM) report later this year that’s “expected to raise a red flag on diagnosis errors and give advocates the fuel needed to focus resources on addressing this cause of patient harm. The shift in healthcare toward value-based care models could help put systems in place that makes the diagnostic process more reliable, experts say.”

The IOM first raised the misdiagnosis consciousness in 1999, with its seminal report, “To Err Is Human.”

It seems to us that the team approach to diagnosis is just common sense. Talk to each other, doctors! And while you’re at it, spend more time with the patient and their family.

Patients, their loved ones and any caregiver can contribute to the body of what’s-wrong knowledge. As Dr. Gordon Schiff, a diagnostic error researcher at Brigham and Women’s Hospital in Boston, told Modern Healthcare in a longer story, “Physicians blame patient ‘treadmill’ for missed calls,” the idea that “this heroic, lone ranger thing the doctor does with the doors closed in their office” is romantic and outdated.

The story discussed the pressures that sow the seeds of our national landscape of diagnostic error. “While the U.S. patient-safety movement has focused enormous attention on medical errors over the past few decades, diagnostic errors have received less attention from practitioners, the research community or patient-safety advocates,” it read. “The extent of the problem is hard to assess as missed diagnoses remain a largely unreported phenomenon.”

Read the whole story to learn more about the ingredients of a major medical problem in our nation, and where we are in trying to solve it. Read Patrick’s current newsletter, “What to Do When the Doctor Doesn’t Know What’s Wrong” to see things from the provider’s perspective, and our backgrounder for general information.

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