Diagnostic errors get no respect

Diagnostic errors are the outcasts of the patient safety movement. Patient safety advocates have long neglected them, giving them far less attention than adverse events such as infections and medication errors, according to an article published today in Health Affairs.

"The topic of diagnostic errors has been strangely absent from the flurry of patient safety activity over the past decade," writes Dr. Robert Wachter, professor and associate chair of the Department of Medicine at the University of California, San Francisco.

That's odd, considering diagnostic errors are frequently the leading or second leading cause of malpractice claims in the U.S., accounting for twice as many alleged and settled claims as medication errors, according to the September Pennsylvania Patient Safety Advisory. About 10 percent of autopsies reveal a diagnostic error that would have altered the patient's care or prognosis, according to Health Affairs.

Wachter tries to explain what's behind the lack of attention to diagnostic errors. Part of the problem, he says, is that the Institute of Medicine's seminal 1999 "To Err is Human" report that helped launch the patient safety movement was written by people who focused on how to improve systems of care.

Medication errors and execution mistakes are amenable to correction via systems corrections. But diagnostic errors are less open to systemwide solutions than medication errors, for example, because they usually are tied to cognitive miscues on the part of one or more members of the medical staff.

One weakness in the healthcare system, Wachter notes, is the lack of a mechanism to measure and promote better diagnostic skills.  Certification boards should play a greater role in ensuring their programs emphasize diagnostic accuracy by requiring more realistic simulations to test competencies, he writes. Board certification could help cut diagnostic errors if certification were mandatory and physicians were reassessed frequently during recertification, not just once every 10 years.

To learn more:
- read the Pennsylvania Patient Safety Advisory
- here is Dr. Robert Wachter's article from Health Affairs on why diagnostic errors don't get respect

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