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Diagnostic Error Workshop: Perspectives from a Librarian/Clinician

by Frances Chu, MLIS, RN/NP
Associate Director of Reference & Outreach, Pumerantz Library
Western University of Health Sciences
Pomona, CA

On March 1, 2013, I attended the workshop Diagnostic Error: A Multidisciplinary Exploration, at Long Beach Memorial/Miller Children’s Hospital, with instructors Mark Graber, MD, Barb Jones, and Lorri Zipperer. The workshop focused on how clinicians make diagnostic errors and how librarians can be involved in a multidisciplinary team to address the issue of diagnostic error. Of interest to me, as a librarian and previously a clinician, were the studies about how clinicians think and make decisions, and how that can lead to diagnostic errors.

Participants of the Diagnostic Error Workshop in Long Beach, CA

Dr. Graber defined Quality as “trying to do everything right” and safety as “trying to avoid doing anything wrong.” This workshop focused on quality as it pertains to the diagnostic process. Dr. Graber cited a study noting that clinicians make mistakes in diagnosis 10% of the time, including the wrong diagnosis, delayed diagnosis, or missed diagnosis. He also noted another study where clinicians rarely have information deficit, but instead they draw the wrong conclusions from the information, due to biases. He discussed Dual-Process Theory, which distinguishes intuitive thinking versus conscious thinking, Availability Heuristics or what I consider pattern recognition, and Biases. These processes can be positive in differential diagnosis, but they can lead to errors. To help identify the “root cause” of these errors, Dr. Graber talked about the techniques of Root Cause Analysis or asking “why,” to identify the basic cause of the error and then look at systems level fixes, in addition to individual level fixes.

Lorri Zipperer and Barb Jones focused on how librarians can help with prevention of diagnostic errors. They defined Data or numbers, Information or textbooks, Evidence or effectiveness, and Knowledge or experience. In the diagnostic error realm, librarians can help by not only providing information and tools for differential diagnosis, but also they can help with evidence, especially if they become involved in the quality and safety operations of the organization. As an example, they encouraged librarians to become involved in Root Cause Analysis committees. They also believe that librarians have to get out of the library and try to be involved in the overarching organization as a whole. To help the workshop participants become comfortable with the process of Root Cause Analysis, we had small group exercises, to walk through the process with hypothetical cases.

From a clinician’s point of view, I am sure I have made diagnostic errors and would loathe to continue making these errors. This workshop would make me think twice about a diagnosis, and consider using some differential diagnosis tools to aid me in this process. However, from a librarian point of view, we also need to look at the quality of our services and resources, and how we can positively impact safety of the patient at an individual person’s level and at a systems level. With this thought in mind, I believe that the MLA Research Section’s Systematic Review Project will help look at the impact of libraries at the societal level, but individual libraries also need to assess and provide evidence of positive impact for their customers/patrons. Additionally, this information was timely, as the academic librarians at Western University of Health Sciences are heavily involved in teaching Evidence-Based Practice (EBP). One course we are involved with is Differential Diagnosis, where librarians provide instruction for differential diagnosis tools that the students learn to use in the theoretical cases. With the new information I have learned, I plan to attend, to observe how the students use these tools and see if they find the tools useful. Then I hope to think of ways to incorporate the information into our EBP instruction and other classes we teach.

Finally, Dr. Graber pointed out the Society to Improve Diagnosis in Medicine, as an organization with a key goal of raising awareness of the prevalence of diagnostic errors, and promoting strategies to prevent them. The Society also sponsors the annual Diagnostic Error in Medicine conference, which will be held September 22-25, 2013, in Chicago, IL. Dr. Graber noted that the conference fee is relatively inexpensive, and interested librarians should consider attending this meeting!

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