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Improving the diagnosis and decreasing the error in health care

The National Academy of Medicine, last week released “Improving Diagnosis in Health Care,” a report that addresses diagnostic errors in health care. The report summarizes the evidence on this broad, system-wide problem and outlines recommendations to make diagnosis more accurate, reliable, efficient, and safe.

The Coalition to Improve Diagnosis, a collaboration of more than a dozen medical societies, health care organizations, patient and consumer advocates, and government partners that brings attention, awareness, and action to the issue of errors in diagnosis.

The Coalition is made up of many of the most prestigious organizations in the medical and patient community and currently includes the following organizations.

  • ABIM Foundation
  • American Association of Nurse Practitioners
  • American Board of Internal Medicine
  • American Board of Medical Specialties
  • American College of Emergency Physicians
  • American College of Physicians
  • American Society for Healthcare Risk Management
  • Consumers Advancing Patient Safety
  • The Leapfrog Group
  • National Patient Safety Foundation
  • Society to Improve Diagnosis in Medicine.

Also supporting the Coalition and its members are government partners:

  • Agency for Healthcare Research and Quality
  • Centers for Disease Control and Prevention.

Members of the Coalition to Improve Diagnosis have agreed to take both individual and collective action to begin addressing the problem of diagnostic error and hope that their work will be a catalyst for translating ideas on how to improve diagnosis and implement concrete changes in health care delivery.

The first job of the Coalition is to bring much-needed attention to the issue of improving diagnosis. “It is an essential step in improving the quality of care patients receive and in reducing harm that can result from diagnoses that are inaccurate, missed or inappropriately delayed.” says Paul Epner, MBA, MEd, chair of the Coalition and executive vice president of the Society to Improve Diagnosis in Medicine.

Organizational members have committed to take measurable action to improve diagnosis through the collective actions of the Coalition as well as opportunities available to and led by each member organization.

The 2015 report Improving Diagnosis in Health Care says that patients and their loved ones should be central members of the diagnostic team; they provide vital input that informs diagnosis and decisions about the path of care. Yet for a variety of reasons, patients may not be effectively engaged in the diagnostic process.

For example, some patients may fear asserting themselves and coming across as “difficult,” because they are concerned that may influence the quality of care they receive. Some may lack familiarity with or adequate access to the health care system. Cultural and language barriers also can be significant challenges to full participation in the diagnostic process. Even if a patient speaks the same language as his or her clinicians, there can be communication challenges if the patient has limited health literacy or if clinicians use unfamiliar medical terminology.

Effective communication and collaboration among all members of the diagnostic team are essential to improve health care and outcomes and to reduce the risk of diagnostic error. Although there are a number of challenges to patient engagement in the diagnostic process, a critical step is for health care professionals and organizations to create environments in which patients and their families can learn about the diagnostic process and feel comfortable participating in this process.

A number of patients, health care professionals, and organizations have developed information and resources to help patients learn about and engage in the diagnostic process. The report features two examples of resources—one by the National Patient Safety Foundation and Society to Improve Diagnosis in Medicine, and the other by Kaiser Permanente—designed to help patients get the right diagnosis.

Checklist for Getting the Right Diagnosis

Tell Your Story Well: Be clear, complete, and accurate when you tell your clinician about your illness.
Be Clear–Take some time to think about when your symptoms started, what made your symptoms better or worse, or if your symptoms were related to taking medications, eating a meal, exercising, or a certain time of day.
Be Complete–Try to remember all of the important information about your illness. Write down some notes and bring them with you. A family member may be able to help you with this.
Be Accurate–Sometimes you may see multiple clinicians during a medical appointment. Make sure your clinicians hear the same story regarding your illness.

Be a Good Historian
• Remember what treatments you have tried in the past, if they helped, and what, if any, side effects you experienced.
• Think about how your illness has progressed over time.
• Think about your family’s medical history and if you may be at risk for similar illnesses.

Keep Good Records
• Keep your own records of test results, referrals, and hospital admissions.
• Keep an accurate list of your medications.
• Bring your medication list with you when you see your clinician or pharmacist.

Be an Informed Consumer
• Learn about your illness by looking at reliable sources on the Internet or visit a local library.
• Learn about the tests or procedures you are having done.
• Learn about your medications:
– Know the names of your medications (both generic and brand names). For example: Tylenol (brand name) and acetaminophen (generic name)
– Know what the medication is for
– Know the amount (dose) you need to take
– Know the time(s) you need to take it during the day
– Know the side effects to watch for and report to your clinician
– Know if the medication interacts with any food or drugs

Take Charge of Managing Your Health

• When meeting with your clinician, use the Ask Me 3 brochure, Good Questions for Getting the Right Diagnosis:
1. What could be causing my problem?
2. What else could it be?
3. When will I get my test results, and what should I do to follow up?
• If you have more than one clinician, make sure each clinician knows what the other person is thinking and planning.
• Make sure each clinician knows all of your test results, medications, or other treatments.
• Be informed and involved in decisions about your health.

Know Your Test Results
• Make sure both you and your clinician get the results from any tests that are done.
• Don’t assume that no news is good news; call and check on your test results.
• Ask what the test results mean and what needs to be done next.

Follow Up
• Ask when you need to make another appointment (follow up) with your clinician once you start treatment.
• Ask what to expect from the treatment or what it will do for you.
• Ask what you need to do if you get new symptoms or start to feel worse.

Make Sure It Is the Right Diagnosis
• Sometimes your diagnosis is the most “likely” thing that is wrong, but it may not be the “right” diagnosis.
• Don’t be afraid to ask “What else could this be?”
• Encourage your clinicians to think about other possible reasons for your illness.

Record Your Health Information and Monitor Your Progress
• Track your health information and share it with your health care team in a structured format.

Before your visit, think about:

  • What you want to talk about during your visit
    What symptoms are you having? How long have you had them? Do they go away? Have you tried any home treatments? If so, what?
  • Inviting someone to go with you
    Bringing someone to your appointment can help you to answer questions and give your clinician information.
  • Write down your questions or some words that will help remind you
    What concerns do you have about your symptoms? What concerns are most important to you?
  • Be prepared
    Be prepared to go over your medications, vitamins, and supplements. Make sure you mention any changes that you have made.

During your visit:

  • Confirm with your clinician why you are there
  • Your symptoms
    When did your symptoms start?
    Do they go away?
    Where are they located?
    How do they affect your daily activities?
  • Share what home treatments you have tried
    Did they help or make your symptoms worse?
  • Share your worries about your symptoms
  • Share what you think might be going on

Your diagnosis: consider asking the clinician:

What else could it be?
• Do all my symptoms match your diagnosis?
• Could there be more than one thing going on? 

At the end of your visit:

  • Make sure you understand what you need to do next
    Repeat your treatment plan and the information you received from your clinician. If you don’t understand, ask your clinician to explain any words or ideas that are confusing. Talk about things that you feel might keep you from following the treatment plan. Talk about other treatment plans or options.
  • Be sure to ask for your after-visit summary
  • Follow all your clinician’s instructions or let them know if you can’t

“Improving Diagnosis in Healthcare” is available online.

Source: http://iom.nationalacademies.org/

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