Patients
Patients obviously have the appropriate motivation to help reduce diagnostic errors. They are perfectly positioned to prevent, detect, and mollify many system-based as well as cognitive factors that detract from timely and accurate diagnosis. Properly educated, patients are ideal partners to help reduce the likelihood of error. For patients to act effectively in this capacity, however, requires that physicians orient them appropriately and reformulate, to some extent, certain aspects of the traditional relationship between themselves and their patients. Two new roles for patients to help reduce the chances for diagnostic error are proposed below.
Be Watchdogs for Cognitive Errors
Traditionally, physicians share their initial impressions with a new patient, but only to a limited extent. Sometimes the suspected diagnosis isn't explicitly mentioned, and the patient is simply told what tests to have done or what treatment will be used. Patients could serve an effective role in checking for cognitive errors if they were given more information, including explicit disclosure of their diagnosis, its probability, and instructions on what to expect if this is correct. They should be told what to watch for in the upcoming days, weeks, and months, and when and how to convey any discrepancies to the provider.
If there is no clear diagnosis, this too should be conveyed. Patients prefer a diagnosis that is delivered with confidence and certainty, but an honest disclosure of uncertainty and the probabilistic nature of diagnosis is probably a better approach in the long run. In this framework, patients would be more comfortable asking questions such as “What else could this be?” Exploring other options is a powerful way to counteract our innate tendencies to narrowly restrict the context of a case or jump too quickly on the first diagnosis that seems to fit.
Be Watchdogs for System-related Errors
In a perfect world, all test results would be reliably communicated and reviewed, all care would be well coordinated, and all medical records would be available and accurate. Until then, the patient can play a valuable role in combating errors related to latent flaws in our healthcare systems and practices. Patients can and should function as back-ups in this regard. They should always be given their test results, progress notes, discharge summaries, and lists of their current medications. In the absence of reliable and comprehensive care coordination, there is no better person than the patient to make sure information flows appropriately between providers and sites of care.
