Effort to Decrease Misdiagnosis Launched | Medpage Today
hmepstein at GMAIL.COM
Fri Sep 14 03:01:56 UTC 2018
Bravo to Paul Epner, Lisa Sanders, and all of the people at SIDM who organized the launch of ACT for Better Diagnosis in DC this morning. For those of you who didn’t get to listen to the webcast, you missed a great event. Here’s an article about it.
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Effort to Decrease Misdiagnosis Launched
-Barriers to accurate diagnosis still present, group says
Joyce FriedenSeptember 13, 2018
WASHINGTON -- Misdiagnosis is still a big problem, and more awareness of the issue is needed, several experts said Thursday.
"Every 9 minutes, someone in a U.S. hospital dies due to a medical diagnosis that was wrong or delayed," Paul Epner, MD, said at an event here sponsored by the Society to Improve Diagnosis in Medicine (SIDM). "It's estimated each year between 40,000 and 80,000 deaths can be attributed to inaccurate or delayed diagnosis."
The event was held to launch the society's "ACT [Accurate, Communicated, Timely] for Better Diagnosis" initiative, backed by more than 40 healthcare organizations. The groups have identified six barriers to improving diagnosis:
Incomplete communication during care transitions
Lack of measures and feedback when an incorrect diagnosis is made
Limited support to help with clinical reasoning
A complicated diagnosis process
Lack of funding for research on the issue of missed and delayed diagnoses
Each group in the ACT coalition has pledged to undertake a project to improve diagnosis, although the specifics are up to them, Epner told MedPage Today. "We're going to continue to support them in their individual efforts ... We're looking for additional organizations that will make effective and impactful actions."
Several speakers at the event described how missed or delayed diagnosis negatively affected their families. Michael "Mick" Night of Orlando, Fla. said that one day nearly 3 years ago, his then 17-year-old athletic and healthy son, John Michael, began feeling dizzy at school, with blurred vision and pain at the back of his head. Night and his wife rushed him to the hospital, where doctors at first "started at the bottom of the list -- it must be drugs, it must be a disease of some sort. Nothing was brought up further than that." It wasn't until the next day -- after they had taken him to another hospital -- that doctors finally diagnosed him accurately with a stroke.
John Michael is still recovering, Night said. "He mostly communicates through his eyes; his speech is slowly coming back ... He spends 4-6 hours a day, 6 days a week, in physical therapy, speech therapy, and occupational therapy, and he's resilient; he's very positive."
"If I was to leave on one note, it would be that youth numbers are growing" for stroke, Night added. "I hope physicians can start looking more at the top of the list first."
Gopal Khanna, director of the Agency for Healthcare Research and Quality (AHRQ), also had his own story. "I lost both of my parents because of [medical] errors which could have been avoided," he said. "As one who specializes in business process re-engineering, I believe processes can be re-engineered so zero harm can be achieved."
About 12 million people annually are affected by diagnostic error, with 4 million suffering serious harm, Khanna said. "That is not acceptable ... The cost [to the U.S. health system] is not just the over $100 billion a year -- it's about human life, and that bothers me."
Diagnosis is a complicated process, and getting it right requires a team effort, said Helen Burstin, MD, MPH, executive vice president and CEO of the Council of Medical Specialty Societies. "It means being able to pull across all kinds of different types of information, whether it's lab reports or radiology, or different types of specialists," she said, adding that problems often develop at the point where information is being sent from one office to another.
Helen Burstin, MD, MPH, executive vice president and CEO, Council of Medical Specialty Societies
Patients also have to be part of the diagnostic process, said Burstin, citing a quote from the late John Eisenberg, MD, one of the first directors of AHRQ: "Patient safety is a team sport, and it can't be a team unless the patient is on it."
Said Burstin, "Patients can bring information to us that we otherwise wouldn't know, and there's often this hesitancy to ask them to bring that information forward."
"I think all of us are touched by this issue," she added. "My father passed away from bladder cancer that his doctors assumed was an enlarged prostate because he was in his 80s. I asked questions, but I didn't ask enough ... even as a physician who often feels empowered to ask those questions."
When it comes to having a diagnostic team, laboratories need to be more active players, said Reynolds Salerno, PhD, director of the CDC's laboratory systems division in Atlanta. "In 2017, clinical laboratories in the U.S. conducted 13.8 billion tests; that's 42 tests for every single American citizen ... It's important for us to think hard about how the lab integrates into the diagnostic system."
Reynolds Salerno, PhD, director, laboratory systems division, CDC
In fact, "one of every three patient encounters involves the ordering of at least one lab test," he continued. "We also know that doctors report uncertainty in test selection about 15% of the time, and uncertainty in interpretation of test results about 10% of the time. We also know ... that lab test results are highly reliable."
"One thing we're trying to do at the CDC is encourage the lab to not look at itself just as a service provider.... but to think of [test] samples as patients who need help, and ask the lab to get more involved in the diagnostic process -- to get outside of the lab and work with clinicians ... to help them figure out which is the best test to order." The agency has developed processes involving diagnostic management teams that include laboratory personnel, and is currently conducting assessments to see how well that has worked, he said.
Last Updated September 13, 2018
Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
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