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The Institute of Medicine Committee on Diagnostic Error in Health Care

David Meyers, MD, FACEP

Over a year ago, the Institute of Medicine convened a committee to study diagnostic errors and make recommendations to reduce them. The effort was described thusly:

Diagnostic Error in Health Care

The committee has met on numerous occasions since its establishment and is now preparing to issue its report, expected in September, 2015.  Although the exact contents of the report are not yet known, the Society to Improve Diagnosis in Medicine, of which I am a board member,  recently convened a group of organizations to form a “Coalition to Improve Diagnosis.” The group’s purpose is to develop strategies and approaches to promote wide knowledge of the report’s findings and recommendations and to drive improvements that will improve diagnosis.

Invitees to this first meeting comprised a diverse group.  Among them were medical professional societies: ACEP, which I represented, the College of American Pathologists (CAP) and other clinical and laboratory pathologist groups, American College of Physicians (ACP), American Board of Internal Medicine (ABIM) and ABIM Foundation (the architect of the Choosing Wisely campaign), the Accreditation Council for Graduate Medical Education (ACGME). Government agencies included the Center for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ).  The Leapfrog Group, the National Patient Safety Foundation, the Joint Commission, the American Hospital Association and the American Society of Healthcare Risk Managers also were at the table as were people from “Get Your Message Right” (GYMR), a public relations firm which SIDM has engaged to facilitate efforts to publicize the report and enhance its impact.  Other parties expressed interest, but were not represented at the meeting; they included the American College of Radiology, American Academy of Family Practice and several patient advocacy groups among others.

Mark Graber, MD, the President of SIDM, opened the meeting with a brief review of the problem of diagnostic errors - prevalence, significant burdens in human and financial terms, human and system factors contributing to the problem, efforts to ameliorate, patient issues, etc.  Then each representative described their organization’s view of the problem, implications for its members or constituents and efforts planned or already underway to address the issues within their frame of reference.

Key issues on which there was general agreement were:
  1. Diagnosis can be a complex and difficult activity with many factors - human and process - affecting the outcome. 
  2. When misdiagnosis or late diagnosis occurs, there may be serious consequences for patients. In addition, there is increasing recognition of the concept of overdiagnosis, the pursuit of a specific diagnosis when such specificity may not benefit and may actually cause harm to a patient; examples of this have led to recent revisions of recommendations for mammography and prostate screening.
  3. Diagnostic errors are a frequent cause of malpractice claims and payouts.
  4. Improving diagnosis is possible by various interventions in the human factors and operational factors sides of the problem.

There was a general acknowledgement by members of the Coalition that the IOM report would be likely to generate a lot of attention to this topic and the IOM Committee’s recommendations will provide a springboard for serious efforts to improve diagnosis.  Until the Report is published, the Coalition could provide a forum for discussion of possible approaches to the expected recommendations, develop strategies to build awareness, test messages with consumers and clinicians and prepare responses to media questions.  When the Report comes out, the Coalition could serve as a clearinghouse for an organized response by those who will be expected to address its recommendations, i.e., clinicians, patients and payers.  It was hoped that each organization would review the IOM report and develop an internal response to the recommendations which would be shared with other Coalition members.  A comprehensive statement would then be drafted outlining the shared principles and planned responses.

At the close of this first meeting, all attendees agreed to take these ideas back to their organizational leadership for discussion.  Future meetings of the Coalition will develop these ideas and plan responses in anticipation of the report. Dr. Gerardi asked me to present my observations to the ACEP Board at the June meeting.  I will keep you posted on future developments.


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