• Michael Misialek, MD

Improving Diagnosis in Health Care

Recently, the Institute of Medicine (IOM) released a report on improving diagnoses in health care. This is an important source of error that has received little attention, until now. Pathologists, as diagnostic experts, are prominently featured and crucial in carrying out the recommendations.

How big of a problem is it?

It is estimated that there are 40,000 –80,000 deaths a year due to diagnostic error. Secret shoppers have found 1 in 10 diagnoses are wrong. Surveys reveal 1 in 3 people have experienced a diagnostic error. It is the most common cause for a malpractice claim. Chart reviews show that 1 in 20 patients will experience a diagnostic error every year. The committee states, “It is likely that most of us will experience at least one diagnostic error in our lifetime, sometimes with devastating consequences.”

Where are diagnostic error most likely encountered?

The ambulatory setting (outpatient) is the setting where error is most commonly found, with 56%. Inpatient is at 28%, while the emergency department comprises 16%.

Why do errors happen?

Errors occur for many reasons. These can be grouped into the following categories:

Patient variables Systems complexities Physician variables

With 10,000 diseases and 5,000 lab tests, it is no wonder there exists the possibility for error.

IOM definition of diagnostic error

Error can be defined in two ways. The failure to:

Establish an accurate and timely explanation of the patient’s health problem(s)

Communicate that explanation to the patient

IOM recommendations

The IOM lists several important recommendations that are of particular interest to pathologists.

In summary, the Society to Improve Diagnosis in Medicine recommends that the CDC should support:

  1. Failsafe communication of lab test results

  2. Funded clinical liaison pathologists in every hospital (IOM)

  3. Funded autopsies at special centers (IOM)

  4. Second opinions on surgical pathology

IOM Conclusion

Diagnostic errors are a significant but underappreciated challenge to health care quality. Getting the right diagnosis is a key aspect of health care. It provides an explanation of a patient’s health problem and informs subsequent health care decisions. Diagnostic errors persist through all settings of care and harm an unacceptable number of patients


Important questions that remain for pathologists include:

1) What are the opportunities and challenges for empowering laboratory professionals to participate in efforts to improve diagnoses?

2) What metrics can reasonably be generated that can link laboratory practices (not necessarily specific to a defined test) to patient outcomes?

3) How can the federal government, particularly CMS, FDA, and CDC, be involved in helping laboratories contribute to improved diagnoses?

Situated at the intersection of all medical specialties, pathologists provide the link between the science and practice of medicine. All treatment begins with a diagnosis. Whether it be the results of a common blood test, tissue biopsy or esoteric molecular analysis, pathologists give direction to the work up of patient problems. A pathologist is a key member of the care team. Any attempt at error reduction must involve leveraging the unique skill set of the pathologist. Follow Path Report for continuing updates on the value pathologists help deliver.

#pathology #error #value #labtests #diagnosis

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