BMJ analysis: Stop the silent misdiagnosis

Three authors from the Dartmouth Center for Health Care Delivery Science authored an analysis in the BMJ, “Stop the silent misdiagnosis: patients’ preferences matter.”

I’ll only provide the bookends of what they wrote.

The beginning:

In recent decades, rapid advances in the biosciences have delivered an explosion of treatment options. This is good news for patients, but it makes medical decision making more complicated. Most critically, an accurate medical diagnosis is no longer sufficient to identify the proper treatment. Just as important is an accurate preference diagnosis. Every option for treatment (a term that we use broadly here, to include procedures, tests, and even watchful waiting) has a unique profile of risks, benefits, and side effects. Doctors, generalists as well as specialists, cannot recommend the right treatment without understanding how the patient values the trade-offs. Regrettably, patients’ preferences are often misdiagnosed. We outline a method for making better preference diagnoses.

The ending:

Better diagnosis of patients’ preferences would repair a fundamental flaw in market based health systems around the world, including the UK’s managed internal market and the wide open US market. For either market to work effectively, there must be an accurate signal of demand. But every preference diagnosis error is also an error in the demand signal. These errors subsequently lead to inaccurate assessments of wants and needs. Decisions on investment or disinvestment cannot be solely based on historical demand, because these figures are distorted by widespread preference misdiagnoses and do not reflect the demands of well informed patients.

Evidence from trials shows that engaged patients consume less healthcare. More work is needed to understand the magnitude of this potential benefit, but it is tantalising to consider that budget challenged health systems around the world could simultaneously give patients what they want and cut costs.

I believe that the full article is freely accessible to anyone online, so please read the full analysis yourselves.

Disclosure, Dr. Al Mulley, one of the authors, and director of the aforementioned Dartmouth Center for Health Care Delivery Science, was a co-founder of the Informed Medical Decisions Foundation, which has been the sole financial supporter of this website project.