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Dr. jackson discusses diagnostic failure in his Web cast

In The Medscape Journal of Medicine's Web cast, "Why We Should Stop Paying for Diagnostic Failure and Its Downstream Consequences," Brian Jackson, MD, MS, medical director of Informatics at ARUP, discusses the danger of undervaluing diagnosis. According to Dr. Jackson, health care organizations and physicians are paid significantly more to treat disease than to diagnose disease in the first place. Dr. Jackson proposes two major areas that need to be addressed: more funded research on the clinical utility of diagnostic tests and better research into diagnosis, which will create a system of rewarding doctors who excel at correctly diagnosing patients.

Complete transcript of Web cast:

Why We Should Stop Paying for Diagnostic Failure and Its Downstream Consequences,

"Diagnosis is dangerously undervalued within the US healthcare system. Doctors and healthcare organizations are paid handsomely to treat disease, but paid comparatively little to establish whether the patient has the disease in the first place. As a result, patients are misdiagnosed and mistreated on a regular basis. In my own specialty of clinical pathology, we see frequent misordering and misinterpretation of laboratory tests.^[1] The direct costs of these tests are, in most cases, fairly modest, but the downstream financial and clinical impact can be huge.

"For example, consider prostate cancer screening: A $20 test (prostate-specific antigen), when used on the wrong patient, might lead to an unnecessary $1000 prostate biopsy, which in turn could lead to an unnecessary $10,000 prostatectomy.

"Ironically, the threat of malpractice, which has emerged as one of the primary economic incentives to diagnose correctly, is arguably compounding the problem by incenting doctors to order unnecessary tests. This leads to more false-positive and ambiguous results, resulting in unnecessary further work-ups and even unnecessary therapy. What is needed is not to globally increase or decrease the use of diagnostic tests, but rather to create incentives for optimizing the application of diagnostics within clinical care.

"I would propose 2 major areas for reform:

• 1. More funded research on the clinical utility of diagnostic tests. Most diagnostic tests in use today have been popularized based on limited clinical correlations; few have any published data on clinical utility.^[2] Better research into diagnosis will also create a basis for identifying and rewarding the doctors who diagnose best and the systems that support them.
• 2. Stop paying for care that results from misdiagnosis. Since misdiagnosis tends to result in more procedures and more office visits, today physicians actually benefit financially from sloppy diagnosis. Stopping payment for these downstream events would create a powerful incentive for improvement.

That's my opinion. I'm Dr. Brian Jackson, Assistant Professor of Pathology, University of Utah, and Medical Director of Informatics at ARUP Laboratories.

Gluud C, Gluud LL. Evidence based diagnostics. BMJ 2005; 330:724–726.

van Walraven D, Naylor CD. Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA 1998; 290:550–558.

About Medscape
The Medscape Journal of Medicine is the original open-access, peer-reviewed general medicine journal, published by Medscape from WebMD^® exclusively online. It runs under the direction of its editor, George D Lundberg, MD.