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“Improving Diagnosis in Health Care”

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Physicians can’t ‘memorize it all’

 

koran

Children memorizing parts of the Koran in Mauritania.

Art Papier, M.D., writes:

“The recently published diagnostic errors report, ‘Improving Diagnosis in Health Care,’  by the Institute of Medicine (IOM) will receive much attention, as it should. … {T}he new report will be transformative because it substantiates how large a problem misdiagnosis is, and will force the medical care system to work on solutions.”

“There are many steps to be taken. One immediate action is to recognize that physicians cannot memorize it all — they require the best information at the right time, which is at the point of care. To curb medical misdiagnosis, our model of what a doctor is and does must change. The IOM diagnostic errors report forces us to think about augmenting our brains, not with simple computer-based references or reliance on more tests, genetic studies, and x-rays, but with new cognitive support systems designed to pull the history and physical exam together to answer questions as we work. New digital systems accessible on smart devices IOMwill engage patients and replace the outdated waiting room clipboard screening questionnaires. Now that the IOM is helping the public realize the extent of the diagnostic errors problem, we can start to invest in new point-of-care information tools as well as new methods to aid thinking, and hopefully diminish the number of patients who are misdiagnosed every year.”


And now on to improving diagnosis

 

xray

This article in the New England Journal of Medicine looks at  the Institute of Medicine’s new report titled “Improving Diagnosis in Health Care — The Next Imperative for Patient Safety.”

The authors of the NEJM piece, Hardeep Singh, M.D.,  and Mark L. Graber, M.D., conclude:

“Now could be an opportune moment to create a national public–private partnership to propel progress. The Department of Veterans Affairs and the Agency for Healthcare Research and Quality have made commitments to improving diagnosis, but the Centers for Disease Control and Prevention, the National Institutes of Health, and the ONC also have interests that intersect with patient safety and could contribute to research and implementation initiatives for elucidating and reducing diagnostic errors. On the private side, a movement is being led by the nonprofit Society to Improve Diagnosis in Medicine, …which petitioned the IOM to study this issue and aims to spearhead a national coalition of professional societies and other interested parties to translate the recommendations into action.

“For the past 15 years, the patient-safety movement has focused on treatment-related harms. But interactions that are too brief to permit clinicians to listen to patients, productivity pressures, and reimbursement systems that don’t adequately support clinicians’ cognitive work are highlighting additional safety issues. ‘Improving Diagnosis in Health Care’ restores balance to the patient-safety quest by calling attention to diagnosis, the other half of medicine. We are optimistic that the report will spark a renaissance of interest in improving diagnosis and reducing patient harm from diagnostic error.”


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