{"id":37102,"date":"2016-07-26T12:02:14","date_gmt":"2016-07-26T11:02:14","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=37102"},"modified":"2016-07-26T12:03:39","modified_gmt":"2016-07-26T11:03:39","slug":"is-there-such-a-thing-as-the-right-diagnosis","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2016\/07\/26\/is-there-such-a-thing-as-the-right-diagnosis\/","title":{"rendered":"Kate Adlington: Is there such a thing as the “right diagnosis”?\u00a0Review from the Diagnostic Error in Medicine conference 2016"},"content":{"rendered":"

\"kate_adlington_pic\"<\/a>As doctors, we probably already consider ourselves honorary members of the Society to Improve Diagnosis in Medicine<\/a>\u00a0(SIDM). It\u2019s essentially part of our job description. But there is an option to become a fully paid up member. Founded in 2011 by US doctor Mark Graber, the SIDM is an international organisation that is dedicated to honouring all those who have been harmed by diagnostic error\u2014aiming to create a “world where diagnosis is accurate, timely, and efficient.”<\/p>\n

The society has hosted several international conferences on diagnostic error. June 2016 saw the first such conference to be hosted in Europe<\/a>,\u00a0with international healthcare colleagues travelling to the impressive Erasmus Medical Centre in Rotterdam, the Netherlands.<\/p>\n

A hot topic of discussion was the recently published US Institute of Medicine landmark report on the problem of diagnostic error:\u00a0Improving Diagnosis in Healthcare<\/a>.\u00a0<\/em>It is sobering reading: 5% of US adults who seek outpatient care experience a diagnostic error each year and diagnostic error contributes to approximately 10% of patient deaths. It concludes that each of us is likely to experience one or more diagnostic errors in our lifetime.<\/p>\n

The committee who produced the report also proposed a new definition for diagnostic error:\u00a0“the failure to
\n\u2022 establish an accurate and timely explanation of the patient\u2019s health problem(s) or
\n\u2022 communicate that explanation to the patient.”<\/p>\n

They were explicit about their intentions to make this definition as patient centred as possible. And indeed it challenges the medical world\u2019s concept of the “right diagnosis.”<\/p>\n

No longer is it enough for doctors to spot the abnormality on the scan or make the correct interpretation of blood test results. If we don\u2019t explain these results clearly to our patients in a way that they understand then we have got it wrong. We have made a diagnostic error.<\/p>\n

The message is that diagnosis doesn\u2019t end with a pat on the back because “we\u2019ve got it right.” Apart from anything else, the diagnosis might not feel “right\u2019 at all for the person sitting in front of us.<\/p>\n

This is part of the ongoing identity shift for doctors from House<\/em> style diagnosticians to person centred “holisticians,” who are concerned with patient experience rather than giving celebrated grand rounds presentations.<\/p>\n

This new definition was largely welcomed at the conference. But for those involved in diagnostic error research, the broadened definition will pose an operational challenge that requires new study designs and outcome measures. The conference organisers committed to improving patient involvement in future to help identify what these desired outcomes might be.<\/p>\n

Other interesting themes at the conference included the use of online tools to help aid diagnosis\u2014particularly useful it seems in the case of rare diseases; the use of psychological theory to establish how individuals make diagnoses and where these thought processes might go wrong; and how system data, such as medical negligence databases, can help to identify where errors occur most frequently.<\/p>\n

The research presented was varied and illuminating. One team in Switzerland explored why there is a high rate of change in individual patient diagnosis between admission and discharge. A British research group described how they are aiming to reduce “unclaimed” investigation results\u2014tests that have been ordered, often in A&E or before a patient\u2019s discharge, that are never checked or communicated back to patients, allowing potential diagnoses to go unnoticed. Another group is addressing the fact that a quarter of cancer diagnoses are made in emergency departments by seeing if there are missed opportunities for diagnosis in general practice.<\/p>\n

Diagnostic certainty was discussed at length. It is rare that doctors can give a diagnosis to patients with 100% certainty. Could diagnostic error be exacerbated by overly confident assertions of the “correct” diagnosis? Might patients be less likely to question ongoing symptoms or return with their concerns if they\u2019ve been inappropriately reassured?<\/p>\n

Safety netting is one way of ensuring patients come back, but do we use it with patient wellbeing and safety in mind or as a way of absolving responsibility in case we\u2019ve got it wrong?<\/p>\n

Might being open and honest with patients, when we aren\u2019t completely sure what\u2019s going on, be the “right diagnosis”?<\/p>\n

Kate Adlington<\/strong> is a clinical editor at <\/em>The BMJ. Follow Kate on Twitter\u00a0@kateadlington<\/a><\/em><\/p>\n

Competing interests:<\/strong> I have read and understood BMJ policy on declaration of interests and declare the following interests: None.<\/p>\n","protected":false},"excerpt":{"rendered":"

As doctors, we probably already consider ourselves honorary members of the Society to Improve Diagnosis in Medicine\u00a0(SIDM). It\u2019s essentially part of our job description. But there is an option to become a fully paid up member. Founded in 2011 by US doctor Mark Graber, the SIDM is an international organisation that is dedicated to honouring […]<\/p>\n

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