Learning From Patients’ Experiences Related To Diagnostic Errors Is Essential For Progress In Patient Safety

Abstract

Diagnostic error research has largely focused on individual clinicians' decision making and system design, while overlooking information from patients. We analyzed a unique new data source of patient-and family-reported error narratives to explore factors that contribute to diagnostic errors. From reports of adverse medical events submitted in the period January 2010-February 2016, we identified 184 unique patient narratives of diagnostic error. Problems related to patient-physician interactions emerged as major contributors. Our analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior, including ignoring patients' knowledge, disrespecting patients, failing to communicate, and manipulation or deception. Patients' perspectives can lead to a more comprehensive understanding of why diagnostic errors occur and help develop strategies for mitigation. Health systems should develop and implement formal programs to collect patients' experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error. D iagnostic errors pose a significant risk to patient safety, affecting an estimated twelve million US adult outpatients annually 1 and leading to an estimated 6-17 percent of all adverse events in hospitalized patients. 2,3 The 2015 National Academies of Science, Engineering, and Medicine report titled Improving Diagnosis in Health Care defined diagnostic error as "the failure to (a) establish an accurate and timely explanation of the patient's health problem(s) or (b) communicate that explanation to the patient." 2(p xiii) This definition signals a shift in focus that includes the patient's perspective in diagnostic error literature and highlights the fact that communication of a health issue to the patient is a fundamental part of the diagnostic process, as patients bear the most risk for harm. 2 Within the diagnostic process, patient-centered care requires strong communication; a willingness to engage patients as participants; and the ability to be responsive to patients' preferences, needs, and values. 2 Continued movement away from disease-or physician-centered care toward more patient-centric care models can foster a trusting and healing relationship between clinicians and patients. 4

Parents’ experiences of seeking health care and encountering allegations of shaken baby syndrome: A qualitative study

“…The diagnostic error had disastrous consequences for the children and their parents. The parental experiences expressed in this study are in accordance with patients' narratives in cases of diagnostic errors; ignorance of patients' knowledge; and disrespect, manipulation and deception [37]. Further, our informants were never informed, nor did they give their consent, about the extended skeletal x-rays and computed tomography that had been performed, which is contrary to Swedish Law (Patient Act 2014:821 & Health Care Act 2017:30).…”

Segurança do paciente no cuidado hospitalar: uma revisão sobre a perspectiva do paciente

“…As for study design, it was observed that most of the articles (37.9%) used mixed methods 15,16,17,18,19,20,21,22,23,24,25 and the same proportion (31%) adopted qualitative 26,27,28,29,30,31,32,33,34 and quantitative approaches 19,35,36,37,38,39,40,41 . There was variation in sample size and type according to quantitative and/or qualitative design.…”

Operational measurement of diagnostic safety: state of the science

“…One limitation of current patient reporting systems is the lack of validated patient-reported questions or methods to detect diagnostic safety concerns. Barriers to patient engagement in safety initiatives, including low health literacy, lack of wider acceptance of safety monitoring as part of the patient role, provider expectations and attitudes, and communication differences, will also need to be addressed to make the most of such efforts [59,61,62]. Real-time adverse event and "near-miss" reporting systems, akin to those intended for use by clinicians, are another potential mechanism to collect patient-reported data on diagnostic safety [63].…”