Keywords<\/em><\/strong>: Misdiagnosis, diagnostic error, participatory medicine, shared decision making, physician-patient communication. The art and science of clinical diagnosis are at the heart of the practice of medicine. But recent study of the accuracy of the diagnostic process in practice has uncovered the uncomfortable truth that more than 150,000 patients per year may undergo considerable preventable harm from incorrect diagnosis.<\/a>[1<\/a>] Misdiagnosis is both widespread and deadly.<\/p>\n Why are there so many diagnostic errors? This is a complex issue, but trying to arrive at a diagnosis in a doctor\u2019s office is often done in a very limited window of time and accomplished with incomplete information. The feedback loop to check the accuracy of the diagnosis is frequently incomplete as well.<\/p>\n The process of arriving at a diagnosis includes gathering relevant information, recognizing a list of possible causes for these findings, using additional information to prune that list, validating the likely cause, and carefully following up to ensure that the ongoing clinical course continues to validate that diagnosis.<\/p>\n My wife experienced the fracture and failure of an indwelling chemotherapy port many years ago, and was aware of a problem long before it was evident to others. She had sensory information no one else had, but was not taken seriously until it was almost too late. <\/p>\n Participatory diagnosis starts with respecting the patient\u2019s perspective on what has transpired. But it goes further.<\/p>\n As recently as last night, when I went to a local hospital with an older family member who had fallen on some stairs, the physician brushed aside our attempts to be involved, beyond giving a basic history. <\/p>\n At one point he said, \u201cWe\u2019re going to do some blood tests.\u201d<\/p>\n I inquired as to what blood tests were being ordered, but was told not to worry about it; they were routine. I pressed further and asked if an INR was ordered (a test used to measure the clotting tendency of blood), noting that the patient was taking an anticoagulant medication. <\/p>\n \u201cYes, along with several other tests.\u201d<\/p>\n When we asked again, \u201cWhich other tests?\u201d we were told that our job was to relax and answer questions. We\u2019d have a time for asking questions at the end, once they had determined the nature of the injuries. We would also have a role in choosing among appropriate treatment alternatives at the end. <\/p>\n But diagnosis was for doctors.<\/p>\n This perspective does not belong to just a few isolated old-school doctors. I\u2019ve encountered it in those who consider themselves to be patient-centric and welcoming of a physician-patient partnership. Otherwise strong (and funny) nationally-award-winning patient education videos tell patients to stay out of the diagnostic process. But last night we, the patient and his family, had additional expertise and inside knowledge with which to consider the emerging data. Our perspective was deemed a nuisance rather than a resource. This led directly to missing an important part of the diagnosis. Taking the time to involve us could have saved time.<\/p>\n No one has a greater stake in the diagnosis than the patients themselves. It\u2019s time to explicitly recognize and welcome their involvement in the diagnostic process. By the time the decision has been made to consult a clinician, patients have already begun to notice findings and generate hypotheses. This is of great value.<\/p>\n Rather than denigrating their partial or complete self-diagnosis, clinicians should encourage, inform, and incorporate the patients\u2019 process as a tool for arriving at the truth. And encourage it all the way through to the end.<\/p>\n Because diagnosis depends on probabilities, some initial error is inevitable. Even at 99.9% accuracy, 1.2 billion physician visits per year in the US could result in more than a million errors.<\/a>[3<\/a>] Involving the patient in followup is a critical part of diagnosis.<\/p>\n Emerging mobile technologies — especially in the hands of patients themselves — offer great promise to prevent medical errors and improve health by gathering better data, suggesting relevant possible diagnoses that might be missed, and closing the loop by building followup and feedback into the system. <\/p>\n Participatory medicine is not just talk. It\u2019s a fundamental shift. And because diagnosis is central to medicine, participatory medicine implies participatory diagnosis.<\/p>\n While the statistics about serious patient harm from misdiagnosis are troubling, they are also a clear measure of how much our health could be improved in the near-term with better diagnosis. Participatory diagnosis is better diagnosis.<\/p>\n Copyright: <\/em><\/strong>\u00a9 2013 Alan Greene. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Rather than denigrating patients’ partial or complete self-diagnosis, clinicians should encourage, inform, and incorporate the patients\u2019 process as a tool for arriving at the truth. Participatory diagnosis is better diagnosis.<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","jetpack_post_was_ever_published":false,"footnotes":""},"categories":[8],"tags":[629,37,77,628,102,178,225],"coauthors":[80],"class_list":["post-3062","post","type-post","status-publish","format-standard","hentry","category-editorials","tag-diagnostic-error","tag-feature","tag-issue","tag-misdiagnosis","tag-participatory-medicine","tag-physician-patient-communication","tag-shared-decision-making"],"yoast_head":"\n
\nCitation<\/em><\/strong>: Greene A. Participatory Diagnosis. J Participat Med. 2013 May 22; 5:e21.
\nPublished<\/em><\/strong>: May 22, 2013.
\nCompeting Interests<\/em><\/strong>: Dr. Greene has worked for a number of eHealth businesses (see author biography).<\/p>\n
\n<\/a>[2<\/a>] Diagnosis is your doctor\u2019s job.<\/p>\nReferences<\/h3>\n
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