Giving and receiving feedback thoughtfully is a skill, one that has the potential to improve diagnostic accuracy.
An article written by Ashley ND Meyer, PhD, of the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, and published in JAMA, outlined the steps to achieving “diagnostic excellence” with feedback being a driving force.
“Achieving diagnostic excellence requires focusing on not just accuracy of diagnosis, but concurrently on minimizing costs and enhancing timeliness and patient centeredness,” wrote Dr Meyer and her colleague, Hardeep Singh, MD, MPH, also of the Veterans Affairs Medical Center. “The best diagnostician may be the clinician who makes the diagnosis using the fewest resources, while improving patient experience.”
The article goes on to note that nurturing “well-calibrated” clinicians is one possible solution to improving diagnostic accuracy. This would include giving constructive criticism and feedback to clinicians. Often, however, clinicians are not likely to receive feedback once they enter practice. If a concerted effort is made to communicate about diagnostic performance thoughtfully, that can help strengthen future efforts.
The vehicle and overall environment for that feedback is important as well. Constructive criticism from a more veteran colleague over a low-key, one-on-one conversation is likely to be more effective than when given during a rigorous performance review-style situation. Feedback may also be best done in teams with a collaborative atmosphere. The communication should be open and receptive to learning about both the positive and negative outcomes. It is difficult to improve without acknowledging mistakes.
Another important factor of “diagnostic excellence” is clearly communicating uncertainty to patients. Although confidence is important, it is just as significant to recognize uncertainty.
“Improving diagnosis in health care is considered the next imperative for patient safety,” wrote the authors. “The future well-calibrated clinician is one of the most promising paths to achieving diagnostic excellence.”
Meyer AND, Singh H. The path to diagnostic excellence includes feedback to calibrate how clinicians think. JAMA. 2019;321(8):737-738.