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And now on to improving diagnosis



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.”

Personalized-medicine focus seen threatening public-health efforts


1802 caricature of Edward Jenner vaccinating patients who feared it would make them sprout cowlike appendages.

Ronald Bayer, Ph.D., and Sandro Galea, M.D., both of the Columbia University Mailman School of Public Health, argue in The New England Journal of Medicine that the federal government and the healthcare industry’s focus on personalized medicine could hurt efforts to improve population health.

They argue that  precision medicine advocates’ focus on treatment  at the individual level means that they tend to ignore such  pressing concerns as  the United States’ low ranking among developed nations in care quality or socio-economic factors’ (aka the “social determinants of health”) big effect on mortality.

The authors say that  the Feds have invested about five times more in  National Institutes of Health research, increasingly focused  on individualized-care models, than in the Centers for Disease Control and Prevention.  And, they write, the proportion of NIH-funded initiatives with “population” or “public” in their names fell 90 percent in the last decade.

“Without minimizing the possible gains to clinical care from greater realization of precision medicine’s promise, we worry that an unstinting focus on precision medicine by trusted spokespeople for health is a mistake — and a distraction from the goal of producing a healthier population.”

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