Does Overtesting Cause Diagnostic Confusion?

Across many parts of the medical profession, the pressure that clinicians feel in trying to avoid unnecessary tests and keep medical costs under control has led to an increased problem in diagnostic issues.

This is the finding according to a leading healthcare expert who was one of the reviewers of the recently released Institute of Medicine Report (IOM) that says most people will experience a misdiagnosis at some point in their lives.

The IOM report indicated higher rates for missed, wrong or delayed diagnoses. However, according to Hardeep Singh, M.D., chief of health policy, quality and informatics at Michael E. DeBakey VA Medical Center in Houston and an associate professor of medicine at Baylor College of Medicine, getting a correct diagnosis can prove to be difficult when a patients’ symptoms and disease conditions change over time.

The fear of overtesting must be balanced with the fear of overdiagnos and the potential of facing a malpractice lawsuit he recently told the Wall Street Journal.

Even though advances in medical technology make it much easier for physicians to have access to electronic health records, researchers have found that abnormal test results are often lost to follow up. Electronic health records or EHR’s are not fool proof and having a system that would track abnormalities would help clinicians to do their jobs better. Sing suggests a type of trigger based intervention that would identify the medical records of patients with delays in diagnosis. If no follow up is documented on abnormal or suspicious items in the EHR within a certain time period, the system would alert clinicians to investigate further.

David D. Koch, president of American Association for Clinical Chemistry, recently wrote an opinion piece that appeared in The Washington Post stating that better collaboration between clinicians and laboratory professionals can go a long way in the prevention of diagnostic errors. Also, clearly informing patients as to when they must follow certain procedures before a test such as fasting in order to insure a more accurate diagnosis is gotten from the tests.

The ICM report also suggests in addition to greater collaboration between medical professionals is making better use of electronic reporting tools and training on how to use them. Also, putting into place policies and procedures that are not punitive when errors are found can go a long way toward improving overall care for patients and their families.

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