Now that the quality movement seems to be chugging along on a well-conceived, evidence-based track, some thoughtful person has come along tooting a horn to warn us to "wait here just a darn minute. Aren't you all forgetting something that's really, really important?"
Or words to that effect.
The man who made such a stir this week, and got my attention, is hospitalist and patient safety expert Robert Wachter MD, an author and associate chair of the University of California San Francisco Department of Medicine.
Measurements of quality—checklists, process measures, and pay for performance score cards—are all fine as ways to reduce medical errors, Wachter says. But they neglect to force us to repair an enormous defect that now exists in the way we care for patients.
Far too often we're getting the diagnosis wrong.
Turns out, the healthcare system performs rather terribly in this earliest stage of the healthcare delivery system. And hospitals, physician groups and quality experts together need to start paying attention, he says.
Wachter gave some examples in his article published this week in the journal Health Affairs "Why Diagnostic Errors Don't Get Any Respect—And What Can Be Done About Them."
First, "approximately one in 10 autopsies uncovers some disease or condition that—had its existence been known when the patient was alive—would have altered his or her care or changed the prognosis," he wrote.
"That number has remained shockingly stable for 30 or 40 years in studies of autopsies," he said in an interview, adding that the error rate continues today, despite the fact that "It's hard to die now without getting a CT or MRI of some part of the body."
According to a 2004 report published in the Archives of Internal Medicine, autopsies revealed incorrect diagnoses among patients hospitalized in the intensive care unit in this order: 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli and nine endocarditis.