JAMA viewpoint article argues for increased emphasis on diagnosis

This week, the Journal of the American Medical Association, JAMA published a viewpoint article entitled “Bringing Diagnosis Into the Quality and Safety Equations,” authored by Mark Graber, one of the leading academics on diagnosis error, Bob Wachter and Chris Cassel, Chair and President of the American Board of Internal Medicine (ABIM).

Login to access the text here: http://jama.jamanetwork.com/article.aspx?articleid=1362034

The article argues strongly that there needs to be an increased focus and emphasis on diagnosis by the healthcare community especially those related to quality and safety.

“Not only is diagnosis critically important to patients, but improving diagnostic skill lies at the heart of efforts to rein in escalating costs of health care. Costs related to diagnostic testing are increasing faster than any other component of health care expenditures.” This is one of the key motivations behind the ABIM Foundation’s recently launched “Choosing Wisely” campaign that has attracted considerable interest.

The article makes a number of suggestions including the use of diagnosis checklists, such as Isabel, to help physicians with constructing a complete differential diagnosis which is “the key challenge in deriving the correct diagnosis.”

Additionally the article notes, “it is telling that hospitals and physician offices now have financial incentives to implement computerized order entry systems (under national meaningful use standards) but not these helpful and relatively inexpensive diagnostic support tools.”  Doesn’t it make sense to also incentivize the use of tools to assist in the decisions that lead up to ordering and treatment?

The Isabel team strongly welcomes this article, particularly as it highlights clearly that diagnosis is not just a niche quality issue but is also “at the heart of efforts to rein in escalating costs of healthcare.” 

As it also states, “no one debates that the right treatment depends on the correct diagnosis” -- which makes it bizarre that we even needed this viewpoint article. How can you worry rationally about the costs of treatment without worrying about diagnosis?