Ignoring Patient Input Tied to Diagnostic Error

Marcia Frellick

November 05, 2018

Patients' views are not often included in records of diagnostic errors, but new data released on November 5 suggest that patient and family narratives may contain key information that should formally be included in the system.

To learn more about how patient experience and patient-physician interactions might affect the risk for diagnostic error, Traber Davis Giardina, PhD, MSW, and colleagues analyzed reports submitted from January 2010 to February 2016 to the nonprofit Empowered Patient Coalition.

The coalition began collecting family experiences to learn more about safety events from the patient's point of view. Patients, family members, and caregivers voluntarily submit data by responding to questions and adding their own text.

Davis Giardina, from the Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey Veterans Affairs (VA) Medical Center and assistant professor of medicine at Baylor College of Medicine in Houston, Texas, and colleagues reported their results in an article published online in Health Affairs.

The researchers identified 184 unique patient stories of diagnostic error. Amid those narratives, problems in patient-physician interactions emerged as a major factor in the errors.

"Our analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior, including ignoring patients' knowledge, disrespecting patients, failing to communicate, and manipulation or deception," they write.

Researchers found 92 narratives by patients and families that included mention of clinicians ignoring or dismissing their reports of such indicators as worrisome symptoms, change in the patient, or failure to improve and that resulted in a diagnostic error.

About two thirds (67.9%) of the narratives were contributed by female patients, and most of the reported diagnostic errors (79.9%) took place in a hospital. Although more than half of participants said that they had reported the incident either to the institution where it happened or to a governing body, only 9% said they were satisfied by the response, the authors write.

Sometimes the narratives told of painful experiences that were brought on by their not being heard and that would last beyond the medical experience.

One woman wrote, "I was her first-born child, had worked in a major teaching hospital for years and thought I could manage her care, and make certain she was well taken care of.... I found I was unable to do so, since I was continually ignored.... I failed her."

In another case reported by a family member, a patient's reports of abdominal pain that lasted over 3 years were ignored.

"One physician even had the audacity to 'listen' to her chest with his stethoscope and NOT put the ear pieces in his ears.... [T]hey were around his neck and then he patted her on the shoulder and told her she was fine and walked out of the room." According to the family member, she was later diagnosed with advanced metastatic colorectal cancer.

The authors call for health systems to develop formal programs to include patients' narratives in the records of diagnostic process.

They highlight as an example the Vanderbilt Patient Advocacy Reporting System, which collects and codes unsolicited patient and family complaint narratives. Reports are reviewed and scored.

High scores bring about an intervention that involves working with clinicians to gradually change behavior.

Coauthors of the study have received funding from the Veterans Affairs Health Services Research and Development (HSR&D) Service and the Presidential Early Career Award for Scientists and Engineers USA, the Agency for Healthcare Research and Quality, the VA National Center for Patient Safety, the Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, the Gordon and Betty Moore Foundation and the National Cancer Institute.

Health Aff. Published online November 5, 2018. Abstract

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