Improving diagnostic performance: Some unrecognized obstacles

Abstract

The growing interest and activity focused on improving diagnostic performance is a needed and welcomed change to which the new journal, Diagnosis, nicely attests. While the importance of raising awareness and building the evidence-base needs to be underscored, these efforts by themselves do not translate directly into improvements for patients. The complex and multifaceted nature of diagnostic work is becoming better understood, yet many of the obstacles seem to operate beneath the surface where the press of daily practice allows many of the untoward issues to be tacitly ignored. The purpose of the paper is to shine a light on some of these less reco gnized issues or obstacles. Among the issues addressed is whether use of the error term as in diagnostic error or medical error is serving us well in gaining of better understanding of diagnostic work, the lack of sensible feedback mechanisms that deny diagnosticians and their organizations the opportunity to learn something about their diagnostic performances, the double-edge nature of feedback, the obstacle of frame blindness, and the need for innovative empirical testing of promising ideas for improving diagnostic performance such as taking advantage of diagnostic simulation techniques that are inexpensive to generate and do not put patients at risk. of patient safety and quality that initially did not receive much attention. While the rise of interest and awareness is a good thing, solely raising awareness does not bring about change. While there is a need for a credible evidence-base, an evidence-base does not guarantee that fruitful interventions and strategies for improving diagnostic performance will be formulated, implemented, and sustained. Those involved in diagnostic pursuits operate in a complex, multifaceted, and extended socio-technical space where many of the obstacles become benignly accepted, consensually neglected, and less recognizable. As discussed next, they need to be highlighted and made more visible.