A third paper, by Robert Wachter, MD, associate chair of the Department of Medicine at the University of California San Francisco, says that far too much attention has been given to medication errors and poor sanitation that result in mistakes.
A much unrecognized problem that results in malpractice cases is that of diagnostic error, "which has been strangely absent from the flurry of patient safety activity over the past decade."
Nevertheless, he says, such errors are common. "Approximately one in ten autopsies uncovers some disease or condition that—had its existence been known when the patient was alive —would have altered his or her care or changed their prognosis." He added that diagnostic error rates average 10% "across a wide range of clinical conditions."
He suggested five approaches to deal with the issue.
- Encourage research on diagnostic errors such as examine training models that may lead to fewer such mistakes.
- Promote actions that reduce errors by emphasizing training that is shown to be associated with better diagnostic performance.
- Use health information technology, such as decision-support systems, if and when they are shown to improve diagnostic accuracy.
- Improve medical teaching through changes to the Accreditation Council for Graduate Medical Education and the Liaison Committee on Medical Education. They "should ensure that residencies and medical schools teach diagnostic reasoning and make more creative use of model patients and simulations in that training."
- Emphasize board certification. Currently, board certification is not mandatory, "and physicians are reassessed quite infrequently during the process of recertification. Most boards require physicians to pass a certifying exam only once every 10 years and many older practitioners have been grandfathered out of this requirement."
He added that these boards need to ensure that their programs emphasize key diagnostic accuracy.