“As soon as I got that diagnosis, everything made sense. I finally understood why I had felt this way for so long, and the doctors finally knew what to do with me.”
“I’ve spoken to 4 doctors about my problems and they’ve all given me a different diagnosis. I don’t think the system makes sense. I don’t fit into any of the boxes.”
“Getting the diagnosis and then the treatment so quickly probably saved my life.”
”As soon as people hear my diagnosis they make assumptions about me. It’s caused me harm.”
These varied statements reflect how patients can experience diagnosis as validating, useful, obstructive, futile, and everything in between. Yet diagnosis continues to play a significant role in healthcare services.
For this reason, ‘improving diagnosis for patient safety’ is a thought-provoking theme for World Patient Safety Day 2024, even more so for mental health service providers, where the very concept of diagnosis is contentious.
Using human factors to improve diagnosis
A diagnosis identifies a patient’s health problem; it gives it a name. Making a diagnosis is often a complex and lengthy process, and errors at any stage can lead to a missed, delayed, or incorrect diagnosis. This can cause significant harm to patients and carers, as the stories below signify:
“I was asking for help for 9 months. By the time I got a diagnosis, I had a damaged lung, hearing loss, and issues with my arteries and heart. On top of that, my mental health had declined and I had left my job.” – Richard
“When my father-in-law got ill, it took months to get a clear diagnosis. During this time there was a lot of uncertainty, his care was fragmented, and he missed out on early intervention. It caused stress for him and us as carers.” – Aurora
An accurate, timely diagnosis is a desired outcome that relies on multiple processes working the way they should. Instead of leaving this to chance, we can design work systems that make it easy to do right and difficult to do wrong.
Why not spend some time at your next team away day reflecting on which systems and processes in your service are working effectively and which are not? Where there are challenges, what system factors are contributing to this, and how can they be addressed? The SEIPS work system explorer is a helpful framework for examining work systems from a human factors perspective.
Diagnosis in mental health services
With diagnosis being debated in mental health contexts, prompted by movements such as ‘A disorder for everyone!’, it is worth considering what patient safety implications may arise from making a diagnosis. How might patients who feel damaged as a result of abuse be affected by receiving a diagnosis of mental illness? How might a highly stigmatised diagnosis impact a patient’s future relationships, career prospects, and healthcare access? We must support patients with unintended consequences of a diagnosis.
At the same time, there are many advantages to receiving a diagnosis when experiencing poor mental health. For example, a diagnosis can enable access to evidence-based treatment and other assistance such as welfare benefits. It can help patients feel validated and reassured that there is an explanation for what they are experiencing. A diagnosis can also guide patients to helpful information, advice, peer support, and self-management resources. All these factors can contribute to meeting a patient’s needs and therefore support their safety.
Involving patients and carers in diagnosis
Whilst ‘collaborative’ or 'partnership’ working have been buzzwords in healthcare for some time, the reality often falls short. Many patients, myself included, still learn about things like their diagnosis and care plan from letters in the post, and are called 'difficult' for challenging diagnoses they disagree with. This World Patient Safety Day, pledge to reduce harm by including your patients and their carers in conversations about their care. When trying to decide between two possible diagnoses, consider asking a patient and their carer to read up on both and see which (if any) resonates with them. How might this approach benefit both you and them? How much time might be saved in the long run by making this decision together rather than in isolation?
To read more about World Patient Safety Day 2024 and the theme ‘improving diagnosis for patient safety’, check out these posts from the World Health Organization and Patient Safety Learning.