Diagnostic errors are a common, yet harmful and costly issue in healthcare. 据估计，每年有1200万美国人受到影响,1和美国国家科学院, 工程, and Medicine (NASEM) note that “all of us will likely experience a meaningful diagnostic error in our lifetime.”2

诊断错误也代表了重大的责任负担. 涉及诊断相关指控的医疗事故案件, 与其他类型的病例相比, 更常见, 会对病人造成更严重的伤害, 并导致更高的赔偿.3

Improving quality of care and reducing diagnosis-related liability exposure requires understanding the diagnostic process and identifying potential areas of risk at each stage. 要做到这一点, experts have advocated for a team-based approach to diagnosis that includes patients/families as essential members of the care team. 

Engaging patients/families as partners in care and crucial members of the diagnostic team may involve reshaping established healthcare norms (e.g., the solo practitioner as the authoritative diagnostician) and addressing other patient engagement barriers, 例如沟通不畅和卫生知识普及不足. The following tips4 offer ways for healthcare providers to nurture patient-centered approaches to care and partner with patients/families for better diagnostic and treatment outcomes.

1.  Invite patients/families to learn about and be active participants in the diagnostic process. 例如, clearly explain the process and encourage patients to provide thorough information about their health and medical histories, 问问题(e).g.还有什么能引起这些症状呢?”)，并跟进测试和实验室结果.
2.  Advise patients on how to be good historians of their medical histories and how to think about and discuss their symptoms (e.g., frequency, location, timing, aggravating and alleviating factors, and associated symptoms). 医疗保健研究机构 & Quality’s (AHRQ’s) Toolkit for Engaging Patients To Improve Diagnostic Safety and NASEM’s Improving Diagnosis in Health Care: Resources for Patients, 家庭, and Health Care Professionals offer helpful tips for improving information sharing. 
3. Optimize verbal and electronic communication with patients/families, 并确保信息及时准确(e).g.、语音留言及电邮回复).
4.  确保病人能够使用必要的系统, 例如患者门户和电子健康记录, so they can review clinical notes and results from diagnostic tests.
5. Recognize cultural competence as a distinguishing feature of patient-centered care and a vital component of developing an effective communication process with patients/families. Use techniques and methods that can aid in cross-cultural communication, 比如动机性访谈, 解释模型, RESPECT模型.
6. 以患者能够理解的方式提供信息, 比如使用视觉辅助工具, providing plain language educational materials and follow-up instructions, and using techniques such as the teach-back method to assess comprehension.
7. Provide patient-friendly tools to assist with information management, 鼓励对话, 支持协作解决问题. Examples of useful tools include Be Prepared to Be Engaged (AHRQ), Ask Me 3: Good Questions for Your Good Health (Institute for Healthcare Improvement), and The Patient’s Toolkit for Diagnosis (Society to Improve Diagnosis in Medicine).
8. Work with patients/families to develop shared knowledge and goals about care and treatment as well as to foster mutual respect and trust.
9. 让病人放心，他们应该对自己的治疗有自信, 引起了人们的担忧, and notify providers if their symptoms change or their conditions worsen or do not improve. 确保病人知道适当的沟通方式.g., appropriate use of patient portals, social media, email, and phone calls).
10. Encourage patients to review their health records for accuracy and completeness and transfer relevant health records and test results to treating clinicians.
11. 公司lude patients/families in efforts to improve diagnosis and learn from diagnostic errors and near misses (e.g.，成立病人/家属咨询委员会).
12. Create opportunities for patients/families to provide feedback about the diagnostic process and any concerns related to their care. 

尾注

1提高医学诊断学会. (n.d.). 什么是诊断错误? 从检索 www.improvediagnosis.org/what-is-diagnostic-error

2美国国家科学院、工程院和医学院. (2015). 提高卫生保健诊断水平. 华盛顿特区:国家科学院出版社.

3 The Society to Improve Diagnosis in Medicine, 什么是诊断错误?

4 .美国国家科学院、工程院和医学院， 提高卫生保健诊断水平; Graber, M.D . Rusz.琼斯先生.弗兰克斯农场，D.琼斯，B.西尔·格拉克，J.托马斯·D. B., . . . Eichbaum,问. (2017). 新的诊断小组. Diagnosis, 4(4), 225-238; National Quality Forum. (2020). Improving diagnostic quality and safety/reducing diagnostic error: Measurement considerations. 从检索 www.qualityforum.org/Publications/2020/10/Reducing_Diagnostic_Error_Measurement_Considerations_-_Final_Reports.aspx; Olson, A.伦契奇，J.科斯比，K.D . Rusz.爸爸，F.克罗斯克里，P.齐勒，B., . . . Graber, M. L. (2019). Competencies for improving diagnosis: An interprofessional framework for education and training in health care. 诊断，6(4)，335-341; Health Research & 教育信托基金. (2018). 提高药品变更包的诊断率. 从检索 www.improvediagnosis.org/improving-diagnosis-in-medicine-change-package/

This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. 因为适用于你的情况的事实可能会有所不同, 或者您所在司法管辖区适用的法律可能不同, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, 州或联邦法律, 合同的解释, 或者其他法律问题.

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