The study looked at 190 cases of diagnostic error highlighted by triggers within the medical record such as unexpected return visits etc. rather than malpractice suits. The settings were two large sites each with a list size of around 50,000 patients-one was public health (Veterans Administration) and the other an integrated private healthcare system. The key points from the paper for us were:
Overall, this is a very revealing paper by Hardeep Singh (one of the most experienced researchers in the area of diagnostic error) and his colleagues. The points raised argue strongly for the requirement that the differential diagnosis should be documented and the patient encouraged to be a partner in this process. The Isabel tools help greatly in both these areas.
The invited commentary to the paper by David Newman Toker is interesting as his estimate of the number of people who might have experienced misdiagnosis related harm has now been put at 150,000 annually in the US alone!
In looking at solutions the commentary states “The answers may well lie in hybrid solutions such as “generically” training physicians in the most effective use of computer based diagnostic decision support tools…”
The role of primary care physicians has expanded, and will continue to do so, with respect to the variety and complexity of medical conditions, which must be evaluated during relatively brief patient encounters. In the light of this, primary physicians should arm themselves with diagnostic decision support aids, like Isabel, and also encourage their patients to help them as much as possible in the diagnostic process; a problem shared is a problem halved.
Jason is the CEO and Co-founder of Isabel. Prior to co-founding Isabel, Jason spent 12 years working in finance and investment banking across Europe. His daughter, Isabel, fell seriously ill following a misdiagnosis in 1999 and this experience inspired Jason to abandon his city career and create Isabel Healthcare Ltd.