Top

Published in:

01-04-2018 | Editorial

General Internists in Pursuit of Diagnostic Excellence in Primary Care: a #ProudtobeGIM Thread That Unites Us All

Authors: Janice L. Kwan, MD MPH, Hardeep Singh, MD MPH

Published in: Journal of General Internal Medicine | Issue 4/2018

Excerpt

Making a correct and timely diagnosis is not only critical to the provision of safe patient care, but central to our identity as general internists. In its absence, preventable harm can occur from delayed, inappropriate, or omitted tests, procedures, and treatments. However, errors in diagnosis are notoriously challenging to study. In 2015, the National Academies of Sciences, Engineering, and Medicine (previously the Institute of Medicine) galvanized renewed focus on diagnostic safety as an integral aspect of health care quality through the publication of Improving Diagnosis in Health Care.1 …

National Academies of Sciences, Engineering, and Medicine Improving Diagnosis in Health Care. Washington, DC: The National Academies Press; 2015.

Neal RD. Tharmanathan P, France B, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 2015;112(Suppl 1):S92-S107. https://doi.org/10.1038/bjc.2015.48.CrossRefPubMedPubMedCentral

Astin M, Griffin T, Neal RD, Rose P, Hamilton W. The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. Br J Gen Pract. 2011;61(586):e231–43. https://doi.org/10.3399/bjgp11X572427.CrossRefPubMedPubMedCentral

Percac-Lima S, Pace LE, Nguyen KH, et al. Diagnostic evaluation of patients presenting to primary care with rectal bleeding. J Gen Intern Med. 2018. https://doi.org/10.1007/s11606-017-4273-x.

Weingart SN, Stoffel EM, Chung DC, et al. Delayed workup of rectal bleeding in adult primary care: examining process-of-care failures. Jt Comm J Qual Patient Saf. 2017;43(1):32–40. https://doi.org/10.1016/j.jcjq.2016.10.001.CrossRefPubMed

Singh H, Daci K, Petersen LA, et al. Missed opportunities to initiate endoscopic evaluation for colorectal cancer diagnosis. Am J Gastroenterol. 2009;104(10):2543–54. https://doi.org/10.1038/ajg.2009.324.CrossRefPubMedPubMedCentral

Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145(7):488–96.CrossRefPubMed

Kravet SJ, Bailey J, Demski R, Pronovost P. Establishing an ambulatory medicine quality and safety oversight structure: leveraging the fractal model. Acad Med. 2016;91(7):962–6. https://doi.org/10.1097/ACM.0000000000001102.CrossRefPubMed

Singh H, Giardina TD, Meyer AN, Forjuoh SN, Reis MD, Thomas EJ. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med. 2013;173(6):418–25. https://doi.org/10.1001/jamainternmed.2013.2777.CrossRefPubMedPubMedCentral

10.

American College of Physicians. Patient safety in the office-based practice setting. Available from: https://www.acponline.org/acp_policy/policies/patient_safety_in_the_office_based_practice_setting_2017.pdf. Accessed January 12, 2018.

11.

Murphy DR, Laxmisan A, Reis BA, et al. Electronic health record-based triggers to detect potential delays in cancer diagnosis. BMJ Qual Saf. 2014;23(1):8–16. https://doi.org/10.1136/bmjqs-2013-001874.CrossRefPubMed

12.

Shekelle PG, Sarkar U, Shojania K, et al. AHRQ comparative effectiveness technical briefs. Patient safety in ambulatory settings. Available from: https://www.ncbi.nlm.nih.gov/books/NBK396055/. Accessed January 12, 2018.

13.

Institute for Healthcare Improvement. Closing the loop: a guide to safer ambulatory referrals in the EHR era. Available from: http://www.ihi.org/resources/Pages/Publications/Closing-the-Loop-A-Guide-to-Safer-Ambulatory-Referrals.aspx. Accessed January 12, 2018.

Title: General Internists in Pursuit of Diagnostic Excellence in Primary Care: a #ProudtobeGIM Thread That Unites Us All
Authors: Janice L. Kwan, MD MPH
Hardeep Singh, MD MPH
Publication date: 01-04-2018
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 4/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-018-4343-8

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 4/2018

Response to Capsule Commentary

Characteristics and Disparities among Primary Care Practices in the United States

Capsule commentary on James et al., Impact of a population health management intervention on disparities in cardiovascular disease control

Gluteal Augmentation-Associated Mycobacterial Infection

The Influence of Financial Strain on Health Decision-Making

Diagnostic Evaluation of Patients Presenting to Primary Care with Rectal Bleeding

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage