Achieving diagnostic excellence is more than a noble act; it is a mandate of our healthcare system. The NASEM report Improving Diagnosis in Health Care concluded that “improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative.”65 It is not a “one and done” but a continual pursuit to deliver care in a way that is truly patient centered if not patient partnered.
Poor communication between medical professionals and patients is a key factor in all diagnostic error, up to 78 percent in primary care settings. Thus, enhancing communication between patients and their healthcare team is central to improving diagnostic quality in this new era of healthcare delivery.66
Improving patient-clinician communication is an intervention ripe with possibilities to reduce diagnostic errors.47 New communication strategies focus on healthcare providers and patients and families. Medical specialty groups67 and general practitioner groups68 are testing and launching their own programs while patient-led organizations are teaching their membership how to speak up and ask questions.
An environmental scan of Patient and Family Engagement Resource Research Questions identified more than 300 versions of “questions to ask your doctor” tools, organized by medical condition and specialty, including patient toolkits.69 AHRQ’s Toolkit for Engaging Patients in Diagnostic Safety70 provides “deceptively simple” strategies to help patients and clinicians bridge the diagnostic communication divide to co-produce an accurate and timely explanation of their health problem.
The ideal form of communication is bidirectional, collaborative, relational, and closed looped.71 The bidirectional form is a respectful back and forth between sender and receiver and a continual exchange of information to determine the diagnosis and build trust. The closed loop is coming full circle on the agreement of that diagnosis. A person has not communicated until they’ve checked for comprehension. If all else fails, just listen to the patient; they are telling you the diagnosis.10
Work remains in the efforts for patients to become partners and coleaders of research.72 As we navigate this transition, it becomes evident that while we may “talk the talk” of equality in partnership and decision making, the infrastructure to support deep collaborations that allows us to “walk the talk” is lacking. A lack of commitment and supportive infrastructure creates a gap between aspiration and reality. This gap sets researchers and involved patients or community members up for failure.
The active involvement of patients represents a paradigm shift essential to achieving the goal of diagnostic excellence. Moving up the ladder of co-production—from being passive recipients of care to becoming active partners and leaders of their own care—has profound implications for enhancing diagnostic accuracy and safety.
The journey toward co-production in diagnostic safety involves creating and sustaining structures that support patient leadership and partnership, bringing valuable insights and lived experiences into the diagnostic process. It requires healthcare systems to embrace transparency, trust, and mutual respect, acknowledging that patients are experts in their own right. This evolution not only enhances diagnostic accuracy but also builds a healthcare system that is more responsive, patient centered, and, ultimately, safer for all.
