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Practice Practice Pointer

Five strategies for clinicians to advance diagnostic excellence

BMJ 2022; 376 doi: (Published 16 February 2022) Cite this as: BMJ 2022;376:e068044
  1. Hardeep Singh, professor of medicine1,
  2. Denise M Connor, associate professor of medicine2 3,
  3. Gurpreet Dhaliwal, professor of medicine 2 3
  1. 1Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston, TX, USA
  2. 2Department of Medicine, University of California San Francisco, San Francisco, CA, USA
  3. 3Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
  1. Correspondence to: H Singh hardeeps{at} Twitter @HardeepSinghMD, @Denise_M_Connor, @Gurpreet2015

What you need to know

  • The World Health Organization and the National Academy of Medicine (US) have identified measuring and reducing diagnostic error as a patient safety priority

  • Diagnosis is a process that is influenced by systems, cognitive, teamwork, and social factors that may either enhance or reduce diagnostic accuracy

  • Clinicians can integrate diagnostic performance feedback into their day-to-day work

  • Clinicians can take steps to mitigate biases (regarding race, ethnicity, gender, and other identities) that run counter to their values and impair diagnostic performance

  • Clinicians can integrate the expertise of other health professionals, patients, and families to reimagine the routines and culture around diagnosis

Diagnostic accuracy is an important component of clinical excellence. However, diagnostic errors—failures to establish an accurate and timely explanation of a patient’s health problem or to communicate that explanation to the patient—harm patients worldwide.12 In a recent UK study, diagnostic errors occurred in 4.3% of primary care consultations.3 A meta-analysis estimated that nearly 250 000 harmful diagnostic errors occur annually among hospitalised adults in the United States.4 The National Academies of Science, Engineering, and Medicine’s report Improving Diagnosis in Health Care highlighted that most people will experience at least one diagnostic error in their lifetime.1 The World Health Organization now identifies measuring and reducing diagnostic error as a patient safety priority.5

Diagnostic excellence involves making a correct and timely diagnosis using the fewest resources while maximising patient experience and managing uncertainty.6 Compared with other patient safety problems such as medication errors, procedural complications, and hospital acquired infections, diagnostic errors have received less investigation.78910 Diagnoses are rendered by clinicians but health system vulnerabilities frequently influence clinical reasoning and contribute to diagnostic error.1112

While system interventions are essential to achieving diagnostic excellence,13 this article focuses on the individual clinician. Based …

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