Presentation
Safety 2Gether: Patients as Partners: Better Teamwork to Strengthen the Ambulatory Diagnostic Process
DescriptionDiagnosis is recognized as a team sport (Thomas & Newman-Toker, 2016) – with many remarking that diagnostic excellence necessitates effective teamwork (Choi et al., 2023). Breakdowns in communication and teamwork contribute to two-thirds of diagnostic errors (Graber et al., 2017). Yet, research in this area remains underdeveloped (Choi et al., 2023). Moreover, more detail is needed when naming communication and teamwork breakdowns as the cause of a medical mistake. For example, Fernández et al. (2024) found 28% of the articles they reviewed named communication as one of the leading causes of medical error, and yet, next to none discuss what aspect of communication caused the breakdown. Given that communication and teamwork are multifaceted competencies, more detail and research are needed to ascertain what is causing diagnostic mistakes to avoid them.
Several recommendations have been made to help engage patients in the diagnostic process (Singh et al., 2017). However, the idea that the patients themselves can be a part of the diagnostic team has yet to be explored. This idea goes beyond patient-centered care; it seats patients at the table. In this oral presentation, we aim to present qualitative interview data that explores the diagnostic process from a multilateral perspective. By interviewing patients and healthcare providers, we provide a comprehensive view of how (and if) patients view themselves as part of their diagnostic team, as well as discerning specific teamwork behaviors patients and practitioners employ throughout the diagnostic process. By doing so, we provide a framework for how teamwork contributes to diagnostic (in)accuracy, delineating specific behaviors that underlie diagnostic success (and errors).
This oral presentation has three main takeaway points: 1) the patient is a part of the diagnostic team, and treating them as such may lead to better diagnostic outcomes; 2) teaming behaviors in the diagnostic process are multifaceted and go beyond communication (i.e., establishing and maintaining team identity), and 3) the healthcare system the diagnostic team is nested within can either greatly facilitate or hinder diagnostic accuracy beyond the patient’s control. This research takes an abductive approach, akin to Bayesian statistics, where the author team flows between inductive and deductive processes to abstract themes from the interview data (see Deterding & Waters, 2021). We anchor our deductive approach to evidence-based teaming behaviors in other settings, and examine inductive insights that are specific to the diagnostic process and/or to patient participation in the team structure. By taking this methodology, we present evidence for the importance of teamwork in medicine (e.g., Hughes et al. 2016; Rosen et al., 2018), more specifically, for the success of the diagnostic process, as well as new insights yet to be remarked. Below, we delineate an early insight from our qualitative data in relation to a patient’s case (using pseudonyms) in their diagnostic journey. We believe this research places the patient at the center and, more so, truly captures the benefits of leveling the medical hierarchy (see Krishnakumar et al., 2021) and listening to patients for improved safety outcomes in the healthcare field.
Patient Tom sought help from Doctor Leslie for persistent coughing. The physician attributed the cough to asthma but did so without thorough questioning, despite notes in Tom’s chart about Tom’s gastrointestinal symptoms. Tom felt unheard, despite his efforts to explain his symptoms. After the initial visit, Tom followed up via the patient portal (as is standard procedure) and explained his ongoing health concerns. However, Doctor Leslie (who did not read the patient’s communication) questioned him for not returning sooner. During a subsequent visit, Nurse Patrick administered a breathing treatment without explanation, which did not help. Despite multiple notes about Tom’s others symptoms, the practitioners overlooked these, and no follow-up was provided. Though Tom eventually found a medication that eased his symptoms, the cause of his coughing remains unknown. Tom’s case highlights the complexities of diagnosis and the importance of patient collaboration to avoid prolonged symptoms. When asked about his diagnostic team, Tom remarked the following: “[...] I don’t really feel like it’s a team. I know that’s strange because they all have access to my record. So you would think they were a team [...], but it’s just not it. I don’t feel like it’s a team, if that makes sense.”
The plethora of issues in this small case study is evident. For example, a lack of psychological safety is evident (see O’Donovan & McAuliffe, 2020); the healthcare practitioners failed to clarify roles and responsibilities; and they did not share information (such as the
purpose of the breathing treatment) with the patient. Moreover, the clear lack of team identity from the patient’s perspective works to feed back into an environment where they do not feel comfortable expressing the entirety of their issues or concerns. Prior literature has recommended that patients prompt providers to think comprehensively about a differential diagnosis (see Singh et al., 2017). Yet – in this case, it is easy to observe how when patients are not considered experts in their own cases and medical histories, this recommendation falls flat, because, ultimately, the doctor considers their expertise “king” (Tom even remarked how he was “just a patient” and they are “medical professionals”). This example illuminates the negative implications of not centering care around the patient and, moreover, paints a clear picture of how patient expertise has a seat at the table. Our presentation will seek to discuss cases like the above, and the diagnostic process itself, marking important points for both patients and providers to help them come together to move towards an accurate diagnosis. We fill a gap remarked on by researchers to go beyond “communication” or general “teamwork” as the cause of a medical mistake (see Fernández et al., 2024). Moreover, our qualitative interview data provides rich examples of the experience of the diagnostic process from both the patient and clinician perspectives, helping us “trace or explain processes by which some outcome occurs” (Rubin, 2021, p. 122).
All references are available upon request.
Several recommendations have been made to help engage patients in the diagnostic process (Singh et al., 2017). However, the idea that the patients themselves can be a part of the diagnostic team has yet to be explored. This idea goes beyond patient-centered care; it seats patients at the table. In this oral presentation, we aim to present qualitative interview data that explores the diagnostic process from a multilateral perspective. By interviewing patients and healthcare providers, we provide a comprehensive view of how (and if) patients view themselves as part of their diagnostic team, as well as discerning specific teamwork behaviors patients and practitioners employ throughout the diagnostic process. By doing so, we provide a framework for how teamwork contributes to diagnostic (in)accuracy, delineating specific behaviors that underlie diagnostic success (and errors).
This oral presentation has three main takeaway points: 1) the patient is a part of the diagnostic team, and treating them as such may lead to better diagnostic outcomes; 2) teaming behaviors in the diagnostic process are multifaceted and go beyond communication (i.e., establishing and maintaining team identity), and 3) the healthcare system the diagnostic team is nested within can either greatly facilitate or hinder diagnostic accuracy beyond the patient’s control. This research takes an abductive approach, akin to Bayesian statistics, where the author team flows between inductive and deductive processes to abstract themes from the interview data (see Deterding & Waters, 2021). We anchor our deductive approach to evidence-based teaming behaviors in other settings, and examine inductive insights that are specific to the diagnostic process and/or to patient participation in the team structure. By taking this methodology, we present evidence for the importance of teamwork in medicine (e.g., Hughes et al. 2016; Rosen et al., 2018), more specifically, for the success of the diagnostic process, as well as new insights yet to be remarked. Below, we delineate an early insight from our qualitative data in relation to a patient’s case (using pseudonyms) in their diagnostic journey. We believe this research places the patient at the center and, more so, truly captures the benefits of leveling the medical hierarchy (see Krishnakumar et al., 2021) and listening to patients for improved safety outcomes in the healthcare field.
Patient Tom sought help from Doctor Leslie for persistent coughing. The physician attributed the cough to asthma but did so without thorough questioning, despite notes in Tom’s chart about Tom’s gastrointestinal symptoms. Tom felt unheard, despite his efforts to explain his symptoms. After the initial visit, Tom followed up via the patient portal (as is standard procedure) and explained his ongoing health concerns. However, Doctor Leslie (who did not read the patient’s communication) questioned him for not returning sooner. During a subsequent visit, Nurse Patrick administered a breathing treatment without explanation, which did not help. Despite multiple notes about Tom’s others symptoms, the practitioners overlooked these, and no follow-up was provided. Though Tom eventually found a medication that eased his symptoms, the cause of his coughing remains unknown. Tom’s case highlights the complexities of diagnosis and the importance of patient collaboration to avoid prolonged symptoms. When asked about his diagnostic team, Tom remarked the following: “[...] I don’t really feel like it’s a team. I know that’s strange because they all have access to my record. So you would think they were a team [...], but it’s just not it. I don’t feel like it’s a team, if that makes sense.”
The plethora of issues in this small case study is evident. For example, a lack of psychological safety is evident (see O’Donovan & McAuliffe, 2020); the healthcare practitioners failed to clarify roles and responsibilities; and they did not share information (such as the
purpose of the breathing treatment) with the patient. Moreover, the clear lack of team identity from the patient’s perspective works to feed back into an environment where they do not feel comfortable expressing the entirety of their issues or concerns. Prior literature has recommended that patients prompt providers to think comprehensively about a differential diagnosis (see Singh et al., 2017). Yet – in this case, it is easy to observe how when patients are not considered experts in their own cases and medical histories, this recommendation falls flat, because, ultimately, the doctor considers their expertise “king” (Tom even remarked how he was “just a patient” and they are “medical professionals”). This example illuminates the negative implications of not centering care around the patient and, moreover, paints a clear picture of how patient expertise has a seat at the table. Our presentation will seek to discuss cases like the above, and the diagnostic process itself, marking important points for both patients and providers to help them come together to move towards an accurate diagnosis. We fill a gap remarked on by researchers to go beyond “communication” or general “teamwork” as the cause of a medical mistake (see Fernández et al., 2024). Moreover, our qualitative interview data provides rich examples of the experience of the diagnostic process from both the patient and clinician perspectives, helping us “trace or explain processes by which some outcome occurs” (Rubin, 2021, p. 122).
All references are available upon request.
Authors
Event Type
Oral Presentations
TimeWednesday, April 210:30am - 10:52am EDT
LocationQueens Quay
Patient Safety and Research Initiatives (PS)