Improving diagnostic performance: some unrecognized obstacles

The growing interest and activity focused on improving diagnostic performance is a needed and welcomed change to which the new journal, Diagnosis, nicely attests. While the importance of raising awareness and building the evidence-base needs to be underscored, these efforts by themselves do not translate directly into improvements for patients. The complex and multifaceted nature of diagnostic work is becoming better understood, yet many of the obstacles seem to operate beneath the surface where the press of daily practice allows many of the untoward issues to be tacitly ignored. The purpose of the paper is to shine a light on some of these less recognized issues or obstacles. Among the issues addressed is whether use of the error term as in diagnostic error or medical error is serving us well in gaining of better understanding of diagnostic work, the lack of sensible feedback mechanisms that deny diagnosticians and their organizations the opportunity to learn something about their diagnostic performances, the double-edge nature of feedback, the obstacle of frame blindness, and the need for innovative empirical testing of promising ideas for improving diagnostic performance such as taking advantage of diagnostic simulation techniques that are inexpensive to generate and do not put patients at risk.