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February 8, 2019

The Path to Diagnostic Excellence Includes Feedback to Calibrate How Clinicians Think

Author Affiliations
  • 1Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
  • 2Baylor College of Medicine, Houston, Texas
JAMA. 2019;321(8):737-738. doi:10.1001/jama.2019.0113

Improving diagnosis in health care is considered the next imperative for patient safety.1,2 Rapidly evolving diagnostic tests and treatments and competing priorities and pressures encountered by clinicians to deliver high-quality, low-cost health care make this a major challenge. Clinicians frequently balance undertesting, possibly missing a diagnosis, with pursuing overzealous diagnostic testing, which could be harmful and costly. Rigorous multidisciplinary research and innovation from cognitive psychology, human factors, informatics, and social sciences are needed to stimulate previous efforts to reduce diagnostic errors. The Moore Foundation’s recently announced $85 million, 6-year initiative on improving diagnostic excellence could be particularly transformative because it “aims to reduce harm from erroneous or delayed diagnoses” but also “goes beyond avoiding errors and includes consideration of cost, timeliness and patient convenience.”3

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    1 Comment for this article
    Cognitive Calibration Won't Work Without Tort Reform
    Edward Volpintesta, MD | Bethel Medical Group
    Ideally, improving analytical thinking will help physicians to better manage uncertainty and reduce overtesting and overtreatment.

    Regardless of whatever methods of ‘cognitive calibration’ are used, however, even the best calibrated clinicians will overdiagnose, overtest and overtreat when the diagnosis is uncertain, the patient’s situation is precarious, and the possibility of litigation looms.

    Until the medical liability system becomes less adversarial and physicians are less vulnerable to unmerited malpractice suits, the benefits of cognitive calibration may never materialize.