Improving diagnosis in health care — The next imperative for patient safety

Abstract

The 1999 Institute of Medicine (IOM) report To Err Is Human transformed thinking about patient safety in U.S. health care. On its 15th anniversary, a topic largely missing from that report is finally getting its due. With its new report, Improving Diagnosis in Health Care, the IOM has acknowledged the need to address diagnostic error as a “moral, professional, and public health imperative.”1 The new report emphasizes that diagnostic errors may be one of the most common and harmful of patient-safety problems.<br><br>Why has it taken so long for the patient-safety movement to recognize the importance of diagnostic errors? Perhaps early safety advocates focused on more glaring problems, such as procedure-related and medication errors, because diagnostic errors are more difficult to detect and understand and less amenable to systems-based interventions. Diagnostic error may involve any of various types of overlapping missed opportunities to make a correct and timely diagnosis; a diagnosis may be missed completely, the wrong one may be provided, or diagnosis may be delayed, all of which can lead to harm from delayed or inappropriate treatments and tests. There are more than 8000 diseases, according to the National Library of Medicine Medical Subject Heading (MeSH) system, and uncertainty is an inherent element at every step of the diagnostic process. Given these complexities, one might argue that getting the final diagnosis right in the great majority of cases is perfectly acceptable.<br>