“Army nurse preparing to enter a COVID-19 positive room to treat patients”. Artist: Sgt. 1st Class Curt Loter via Bayne-Jones Army Community Hospital.

“Diagnostic errors are especially prone to raise concern among clinicians because they are associated with physicians’ self-identity and are often viewed as personal failings resulting in feelings of shame rather than as a signal to investigate the systems issues behind the problem. Because the underlying data are often imperfect, physicians often challenge their accuracy rather than interpret them as a call for improvement.

The health care profession needs to accept that physicians, being human, are fallible—systems of care to reduce diagnostic errors to a minimum must be designed. ED overcrowding is not an emergency medicine problem. It is a system problem and requires a system-level solution. Specific diagnosis-focused solutions might include checklists or cognitive aids that are pushed real time to clinicians, capturing, correcting, and preventing diagnostic errors in a timely and blame-free way. Machine learning, better access to advanced imaging and specialist consultation, development of reliable diagnostic biomarkers, improvements in health information technology, and clinical decision support need to be studied and employed as parts of the solution. Training modules that target the big 3 disease entities need to be developed at the medical school, residency, and practicing physician levels for all specialties involved in diagnosing those patients.”

Misdiagnosis in the Emergency DepartmentTime for a System Solution via JAMA.

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