"Likewise, it is easier to measure whether surgeons called a "time out" before surgery, or whether a series of processes was performed to prevent central line infecitons.
"Diagnostic errors mostly reflect cognitive issues, such as failing to adequately consider alternative diagnoses," Wachter wrote. "No comparable series of processes (or structures) has been identified to prevent them."
Diagnostic errors, Wachter says, "don't elicit the visceral dread that accompanies wrong-site surgery." And, he says, "none of the examples of medical errors that produced an uproar in the media has involved a diagnostic error."
Wachter suggests five ways to start addressing this system of neglect:
- Improve board certification standards by requiring more frequent reviews and perhaps annual maintenance of certification documentation, with hospitals making that a requirement for staff privileges for certain specialties. Already, he says, efforts are underway to make this process more rigorous and remove some of the grandfather privileges that exempt doctors trained decades ago if they are still practicing.
- Encourage research on diagnostic errors to better understand how and when they happen, and whether computerized decision support tools reduce them. The AHRQ has provided some seed funding for such research.
- See what sorts of training are associated with improved diagnostic performance, and hospitals should be required to offer them or ensure that their medical staffs participate in them.
- Use technology, perhaps some of the $20 billion in federal support from the stimulus bill, to find health information technology strategies that reduce diagnostic errors.
- Improve medical teaching by having the Accreditation Council for Graduate Medical Education ensure that residencies and medical schools train students in diagnostic reasoning, including more creative use of simulations and model patients.