Tempo de leitura: 7 minutos
Reducing diagnostic error in Medicine is the personal life quest of our first international “Great Name of Clinical Reasoning”, Dr. Mark L Graber.
Dr. Graber is an internist and the former Chief of Medicine at the VA Medical Center in Northport, NY. He founded “Patient Safety Awareness Week” in 2002, an event now recognized at hospitals internationally.
Dr. Graber is considered the ‘father’ of efforts to address diagnostic error. In 2008 he founded the Diagnostic Error in Medicine conference series, in 2011 he founded and now leads the Society to Improve Diagnosis in Medicine (SIDM), and in 2014, with Dr. Mario Plebani, he founded the new jornal DIAGNOSIS.
He has authored numerous papers on the topic of diagnostic error, including one of the first studies to examine the cognitive- and system-related causes in cases of diagnostic error. His work has been funded by the Department of Veterans Affairs, the National Patient Safety Foundation, and the Agency for Healthcare Research and Quality.
As president of SIDM, Dr Graber successfully petitioned the Institute of Medicine to conduct a major study on the problem of diagnostic error, and the resulting report, Improving Diagnosis in Health Care, is now the definitive compilation of what’s known about the problem. The report makes 8 major recommendations on what should be done to reduce the risk of harm.
For his efforts to improve patient safety and diagnostic error in particular, he received the 2014 John M Eisenberg award from the National Quality Forum and The Joint Commission, recognizing individual achievement in this growing field.
Dr. Mark Graber kindly agreed to answer a few questions from our blog. Read below what he has to say about diagnostic error, clinical reasoning and medical education!
RACIOCÍNIO CLÍNICO: Dear Dr. Graber: About the Society to Improve Diagnosis in Medicine (SIDM), from which you were one of the founders: when was SIDM stablished? How many members are effectively participating now, and what is their geographic distribution?
DR. MARK GRABER: I founded the Society in 2011 as a non-profit group focused on reducing diagnostic error. I had founded the Diagnostic Error in Medicine conference series 3 years earlier, but we felt that a sustained year-round effort would be needed to address diagnostic error, not just a once-a-year event. We now have 250 active members, over 1000 listserv participants, and over 3000 people have attended the DEM conferences.
RACIOCÍNIO CLÍNICO: What are the main goals of SIDM? What activities is the Society currently developing?
DR. MARK GRABER: Our vision is that no patients are harmed by diagnostic error. We believe diagnosis should be timely, accurate, eficiente, and safe.
We have 2 major success stories to date:
– We succeeded in having the US Institute of Medicine (now the National Academy of Medicine) conduct and publish a major report on diagnostic error, Improving Diagnosis in Health Care, which has been downloaded over 20,000 times to date;
– We also succeeded in convening and now we are leading theCoalition to Improve Diagnosis), a group of now 35+ major professional groups and organizations, each dedicated to both collective and individual actions to address diagnostic error.
We have many other interesting projects and very active committees. Our Education Committee has created a toolkit for educators, and is now working with the Macy Foundation to create a curriculum on diagnosis and diagnostic error. Our Research Committee sponsors an annual Research Summit. Our Patient Engagement Committee created a toolkit for patients. Our Practice Improvement Committee is working on guidelines for handling incidental findings, and another on improving consultation.
“Our vision is that no patients are harmed by diagnostic error.”
RACIOCÍNIO CLÍNICO: Based on your expertise on the subject and on the available evidence, what are the most useful and cost-effective interventions to reduce the risk of diagnostic error in medical practice?
DR. MARK GRABER: There is hardly any hard evidence on what interventions work, or work most effectively. That work is just beginning. But based on our current understanding of the problem, there are actions that each of the major stakeholders can take to begin addressing the problem:
Clinicians: Should not trust their intuition; they should practice reflectively. They should make the patients a partner in the diagnostic process. They should use decision support resources to enhance differential diagnosis, and take advantage of second opinions. They should track tests and consults ordered, and make sure all results are tracked and followed up.
Healthcare organizations: Should create a climate of safety and open discussion. They should find and learn from the diagnostic errors in their systems. They should provide an electronic record, with decision support for diagnosis. They should facilitate second opinions.
RACIOCÍNIO CLÍNICO: What is the role of patients in diagnostic safety?
DR. MARK GRABER: Patients need to serve as their own safety net to prevent harm from diagnostic error.
Patients should be engaged participants. They should keep their own records, and always ask ‘What else could it be?’ They should take advantage of cancer screening. They should know how to follow up if symptoms persist or don’t respond to treatment.
RACIOCÍNIO CLÍNICO: What is the relationship between the Society to Improve Diagnosis in Medicine and the Medical Education establishment (medical schools and teaching hospitals) in order to improve medical curricula to properly address clinical reasoning and diagnostic error? And what do you think about a medical undergraduate course curriculum based on clinical reasoning or decision making?
DR. MARK GRABER: SIDM has many members who are active educators, or members of academic programs. Our Education Committee has many projects to improve both undergraduate and postgraduate training on clinical reasoning and diagnostic safety. We have an active project with the Macy Foundation to create a consensus-based, interprofessional curriculum to improve diagnosis, which will emphasize clinical reasoning, and address the many system-related and cognitive errors that contribute to diagnostic error and harm. This curriculum will be completed in 2018 and trialed at medical schools nationally in 2019.
RACIOCÍNIO CLÍNICO: How can we, in Brazil, help SIDM to reach their goals? Is it time for the SIDM to go International? And, for last: what do you think about an international conference on Diagnostic Errors here in South America?
DR. MARK GRABER: We are delighted to hear of interest in Brazil to improve diagnosis and welcome your help and participation in these efforts. In addition to our annual Diagnostic Error Conference in the US, SIDM has now sponsored and helped support international conferences in Europe (Rotterdam 2016), Australia (Melbourne 2017) and again in Europe (Berne) in 2018.
If there is a team in Brazil interested to host a conference, and a willing academic institution to act as a partner, a conference in Brazil is certainly possible, and this would be an outstanding opportunity to stimulate interest and action to address diagnostic error in Brazil and throughout South America.
We are very thankful to Dr. Mark Graber for his kindness in answering our questions!
Keep following our website for more exciting news!
Graber ML, Franklin N, Gordon R. Diagnostic error in Internal Medicine. JAMA Internal Medicine, 2005.
Institute of Medicine (IOM). Improving Diagnosis in Health Care. Washington: IOM, 2015.