IOM’s Committee on Diagnostic Error

David Meyers, MD, FACEP

Over the past year or so, I have been following the efforts of the Institute of Medicine’s Committee on Diagnostic Error. The committee is charged to develop recommendations to reduce diagnostic error across health care and identify action items for key stakeholders who focus broadly on education, the culture of health care, information technology, systems engineering, measurement approaches, changes in payment, and further research - all areas which play a role in this problem.

Awareness of the scale of the problem of diagnosis errors has been growing in recent years as more and more notorious cases have come to public attention, including, most recently, the misdiagnosis of Thomas Duncan’s Ebola infection in Texas a few months ago. Surveys of the public have shown that more than 50% of Americans have personally or know someone who has experienced a diagnostic error. Of course, these could be non-significant in terms of true health impact or very serious up to and including death or permanent severe disability. The human costs, as well as monetary costs, are huge. A recent scholarly article, authored by Dr. Mark Graber, of the IOM panel, on this subject can be found here.  Another very good review of the entire field was published last spring by the Urban Institute’s Dr. Robert Berenson, also a member of the Committee. In this article, the many unconscious bases influencing our decision-making and other behavior are reviewed.

The IOM panel was convened early in 2014 with support from a number of organizations, including the AHRQ, College of American Pathologists, American College of Radiology, Cautious Patient Foundation and others. Its 21 members come from a spectrum of interests including clinical, academic, regulatory, process engineering, industry and others. The Committee has held 4 full sessions, and the 3 held in Washington were at least partly open to the public for observation and comments. At these open sessions, a broad range of experts - physicians, researchers, educators psychologists, behavioral economists, patients and patient advocates, process engineers, statisticians, insurers and others - submitted information and ideas about the scope and nature of the problem, the many factors which contribute to such errors, the patient perspective on the issue, possible approaches and tools to reduce such errors. A webinar on cognition was also held last month. Dhaliwal’s presentation was especially interesting. It should be available very soon on line.

Clearly, the main focus seems to be errors of misdiagnosis and late diagnosis, but there is also some interest in “overdiagnosis”, the pursuit of unlikely diagnoses in the interest of defensive medicine or “thoroughness”, the identification of diseases which might be treated by drugs created by Big Pharma (“low T)” and new calls to rethink screening for breast, prostate and other cancers.

A Call to Action
As specialists sought out by 10s of millions of patients each year, emergency physicians will undoubtedly feel the impact of whatever recommendations come out of this committee next September. QIPS Section members are leaders - in their hospitals and in the wider world - in defining, studying and reducing diagnostic errors. In a conversation at the 2014 Scientific Assembly, Mike Gerardi, ACEP’s President-Elect, and I spoke about his interest in this issue and further engaging the College in helping to address the issue. Since then, our College has started to draft comments on the subject to be submitted to the IOM Committee in the near future. Rather than passively waiting for the IOM report to come out and tell us what should be done, we members of the QIPS section can take the opportunity to submit comments directly to the IOM and/or work with Stacie Jones, me, Chris Beach, Sandy Schneider and others who are working to draft comments for submission on behalf of the College. You can also sign up for the IOM Committee’s mailing list. Another avenue for gaining information and ideas on the topic is the Society to Improve Diagnosis in Medicine, several of whose members are on the IOM panel and whose listserv has an ongoing discussion of many aspects of the problem. Please contact me if you have interest or questions about the diagnostic errors movement, the IOM Committee or the Society to Improve Diagnosis in Medicine.


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