Two overarching philosophies continue to shape the terminology used about diagnosis. They create both challenges and opportunities as terms are refined and patients and caregivers are incorporated into the discussion. Both are needed to frame and continually refine the understanding and use of diagnosis-related terminology.
Humans as Problems or Assets
The concept of diagnostic error and Safety-I imply that humans are the flaws within the system that need to be controlled. Safety-II and resilience engineering position humans as valuable assets capable of driving improvements. This dichotomy influences approaches to diagnostic improvements.
The skills and expertise of professionals committed to excellence should be celebrated, encouraged, and supported in medical culture. A system that recognizes the wisdom of frontline clinicians will benefit from their contribution to excellent care in safe systems. Diagnosis terminology can recognize the dynamic contributions of humans as the most valuable resource we have for achieving diagnostic excellence.
Focus on Problems or Opportunities
Second, a focus on identifying problems rather than recognizing successes or opportunities can hinder progress in achieving diagnostic excellence. Shifting to a mindset of continuous improvement reframes challenges as opportunities to evolve systems capable of better care. A reframed focus on the positives does not equate to ignoring opportunities for improvement. Instead, the shifted language allows an open, growth-minded culture that invites a focus on continuous improvement. This guiding philosophy can continue to benefit the diagnostic discipline as terms and perspectives evolve.
Recommendations for Practice
To address diagnosis-related terminology challenges and opportunities, healthcare systems and training programs may advance diagnostic improvement if they support and encourage the following:
- Understand and intentionally use terms that create shared meaning and avoid ambiguous language. Regardless of the specific terminology adopted for the purpose, individuals should be explicit and clarify what is meant, including assumptions and related methods used to study, measure, and improve.
- Recognize that the language of diagnosis, assorted descriptions for diagnostic error, and various approaches to understanding and improving diagnosis are all relevant and useful to address diverse goals and the many facets of diagnostic complexity. Develop training programs and educational initiatives that emphasize a shared understanding of the history, complexity, and systems-based nature of diagnostic excellence.
- Recognize that patient and caregiver terminology related to diagnosis complements healthcare provider terminology. Integrate patient and caregiver perspectives into diagnostic processes to learn from them. Identify and use terms that resonate with patients and caregivers while maintaining clarity and precision.
- Work to bridge linguistic differences to enable a shared understanding of diagnostic terminology.
The concepts articulated within this issue brief are intended to stimulate further understanding and refinement of the language and concepts reflected in diagnostic terminology. A rich and precise diagnostic vocabulary emerges from the careful understanding of language across different perspectives. Healthcare professionals and organizations can benefit from awareness of the general principles and various models captured in the terms described in this brief. Knowledge of the history of these terms, the perspectives in which they originate, and their practical applications will improve communication, enhance collaboration, and ultimately advance patient outcomes.
