Diagnostic errors are a common and important problem carrying enormous costs in both dollars and human suffering. Dr Mark L. Graber, president of the Society to Improve Diagnosis in Medicine and a national leader in the field of patient safety, presents his views on improving diagnosis by improving education.
By Mark L. Graber
Diagnosis makes up roughly half of medical care (management and treatment are the rest). With diagnosis taking such a prominent role in healthcare, one would think that there would be a mandatory course on diagnosis in schools of medicine, nursing, etc.? Wrong! You’d have a hard time finding this course in the US, or anywhere in the world. Traditionally, trainees learn these skills not in a course, but by watching their teachers in clinical practice settings, and emulating their approach. It’s an apprenticeship model, like learning how to shoe a horse.
Depending on how you look at things, the apprenticeship model works: Clinicians in practice get the diagnosis right 90% of the time. But the other 10% represent literally tens of thousands of patients harmed or dying every year from diagnostic error. Can’t we do better than 90%?
Improving diagnosis by improving education
Everyone agrees that the fundamental task of healthcare education is to learn the fundamentals of your profession, all of the content that is already present in healthcare education allowing you to recognize a disease and to distinguish it from others. The article Improving Diagnosis by Improving Education, recently published in the Journal Diagnosis, represents the first steps in defining what should be included beyond that content.
Over the last 2 decades, so much has been learned about how to improve diagnosis and to prevent diagnostic error: How to optimize clinical reasoning to reduce cognitive error, understanding system-related aspects of care, how to engage patients, nurses and others in the diagnostic team, and appreciating how diagnostic errors arise and can be prevented. This new content is relevant to students in every healthcare profession, and needs to be incorporated into their education and training programs as soon as possible to improve both the quality and safety of diagnosis in practice.
In their report on Improving Diagnosis in Healthcare the National Academy of Medicine strongly recommended that diagnosis could be improved by improving education. This represents the first steps towards achieving that goal.
Read the original article here.
Mark L. Graber, Joseph Rencic, Diana Rusz, Frank Papa, Pat Croskerry, Brenda Zierler, Gene Harkless, Michael Giuliano, Stephen Schoenbaum, Cristin Colford, Maureen Cahill, Andrew P.J. Olson: Improving diagnosis by improving education: a policy brief on education in healthcare professions. 27.08.2018