The Institute of Medicine on Diagnostic Quality

The Institute of Medicine has issued a series of reports focused on quality in health care, particularly errors or safety problems.  The latest in the series deals with errors in diagnosis.   (IOM Report)    According to the authors, most Americans will endure at least one diagnostic error in their lifetime, 5% of adults seeking care in any year will experience such an error; diagnostic errors contribute to about 10% of patient deaths and account for 6% to 17% of adverse events of hospitals.  So it is a serious quality problem.  The diagnostic process is fairly simple.  The patient presents with symptoms and the clinician gathers a variety of data, from history to demographic information to environmental factors, and typically may order a number of diagnostic tests.  There can be iterations of the process from complex conditions and a number of other professionals may be involved, such as radiologists and pathologists.  Errors can arise both in the collection or generation of the data and the interpretation of it.  Missed diagnoses lead to failure to treat; wrong diagnoses lead to the wrong treatment.  In both cases, the patient’s health likely worsens.

Some of the observations regarding the diagnostic process and issues that contribute to errors include inadequacies in clinician education that fail to highlight the diagnostic process and how to maximize use of that process; health information technology often is actually a barrier to good information communication and coordination of care; and a failure of the system to recognize potential diagnoses issues and to have formal efforts to learn from mistakes and improve outcomes.  Liability concerns may lead to a failure to openly acknowledge diagnostic mistakes.   The IOM gives several recommendations, which generally are broad-brush, to ensure better diagnostic performance.  One of the most important is the need to acknowledge errors when they occur and use them as an opportunity to improve.  Liability concerns do impede this objective and need to be addressed.  The report is lengthy and detailed and gives interested persons good insight into an aspect of health care that is not often explored in-depth.