Gaining Momentum to Improve Diagnosis in Medicine

By Chris Goeschel, ScD, MPA, MPS, RN

Earlier today Facebook reminded me of a memory from 2015. I am not a daily FB user, and I limit my posts to select, real friends, versus the “I know someone who knows you“ category social media tends to classify as “friends”. Ironic that the post referred to an Institute of Medicine (IOM) Panel on which I had served for 2 years, and the report that our committee released in September 2015 on “Improving Diagnosis in Health Care”. Two years ago an article discussing the findings and importance of our report appeared in the New York Times. My FB post included a link to the article.

Today, as I write this I am sitting on a plane headed to Boston for the 10th annual meeting of the Society to Improve Diagnosis in Medicine(SIDM). My mind drifts to the ways in which life has a way of merging events that occur in isolation, but create reality for individuals. Thirty years ago today my 67-year-old father died from a cancer that was treated as an infection until just weeks before he died. Missed diagnosis? Delayed diagnosis? For me, the memory is he died too young, too quickly, and in a way that surprised his physician, who cried when he told our family that in fact, it was not an infection it was cancer. We have come a long way in 30 years, right? My father never knew a cell phone, TV remotes were the “new thing”, and computers were just starting to make a dent in how we work and live.

In some ways progress has been astounding; in other ways the pace of change is frustratingly slow. Last week a team of MedStar Institute for Quality and Safety colleagues and I met with others from six healthcare organizations from across the country, SIDM leaders, and leaders from the Institute for Healthcare Improvement (IHI). Together we committed to 9 months of intensive work developing a “prototype” collaborative to guide organizations that are serious about improving diagnosis. The SIDM conference that I attended had more poster presentations than they could handle, and the lineup of speakers transcends from gurus in the quality and safety space (Don Berwick, Dave Mayer, and Amy Edmondson among others) to physicians, nurses and health services researchers in the trenches, who are all too aware that missed diagnosis, incorrect diagnosis, and delayed diagnosis remain a looming challenges.

Perhaps I should not have been surprised that when I shared my Facebook “memory”, the comments from friends included new stories of how “we” got it wrong, got it “late” or didn’t listen when they tried to TELL us what was going on with their health. These stories are sources of real dissatisfaction.

The report from our IOM panel suggested that each of us will experience at least one diagnostic error in our lifetime. An important way to help mitigate this reality is to acknowledge that diagnosis really needs to be a team endeavor. The ideal team benefits from patients and families at the center surrounded by physicians, nurses, allied health professionals and others, working together, sharing information, insights, concerns, and successes on behalf of better health for individuals and populations. Watch this space for how to join us on the journey.

I welcome your comments, questions and stories at mailto:[email protected].