BMJ article 

Five strategies for clinicians to advance diagnostic excellence

BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-068044 (Published 16 February 2022)

Cite this as: BMJ 2022;376:e068044

Key ideas 

Diagnosis 

is a process that is influenced by systems, cognitive, teamwork, and social factors that may either enhance or reduce diagnostic accuracy

Diagnostic error

failures to establish an accurate and timely explanation of a patient’s health problem or to communicate that explanation to the patient—harm patients worldwide.

Diagnostic excellence

Diagnostic accuracy is an important component of clinical excellence

Diagnostic excellence involves making a correct and timely diagnosis using the fewest resources while maximising patient experience and managing uncertainty

Why diagnostic errors occur

Diagnosis is a complex categorisation task driven by mental models (illness scripts and diagnostic schemas) that reside in long term memory. Through education and experience, clinicians form illness scripts that encapsulate their knowledge of specific conditions (such as osteoarthritis) and develop diagnostic schemas that structure their approach to a specific health problem (such as knee pain).

notes 

The strategies seem useful. They don't appear to be anything new. It's not easy to remember the list. I suggest an alternative structure could be 

1. Individual-level strategies eg solicit and provide feedback, recognise bias and be critical 

2. Team level strategies eg create space for diagnostic excellence, foster psychological safety 

3. The organisation, or systems, level strategies - provide resources, leadership, vision for diagnostic excellence.