Improving diagnosis: adding context to cognition

Abstract

Background The environment in which clinicians provide care and think about their patients is a crucial and undervalued component of the diagnostic process. Content In this paper, we propose a new conceptual model that links work conditions to clinician responses such as stress and burnout, which in turn impacts the quality of the diagnostic process and finally patient diagnostic outcomes. The mechanism for these interactions critically depends on the relationship between working memory (WM) and long-term memory (LTM), and ways WM and LTM interactions are affected by working conditions. Summary We propose a conceptual model to guide interventions to improve work conditions, clinician reactions and ultimately diagnostic process, accuracy and outcomes. Outlook Improving diagnosis can be accomplished if we are able to understand, measure and increase our knowledge of the context of care.

You Cannot Function in “Overwhelm”: Helping Primary Care Navigate the Slow End of the Pandemic

“…Most clinicians are used to functioning under stress and have been able to modulate demands via controls of the work environment such as creating patient visits of different lengths (Linzer et al, 2014). But (Brown, 2021) These adverse outcomes affect cognition and the ability to make diagnoses (Linzer et al, 2022), and can interrupt care for prolonged periods until support systems are reestablished to modulate workflow. This situation became profoundly apparent in primary care during the pandemic.…”

How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care

“…To explore connections between work conditions, stress and burnout and diagnostic quality (element inclusion), physicians completed a Worklife and Wellness Mini Z survey form27 28 shortly after the session where their visits were recorded. At the end of each encounter, researchers asked physicians about the perceived time needed for the encounter.…”

“…Because diagnosis often occurs in time-constrained, stressful and chaotic settings, we sought to contextualise our findings with a more complete understanding of conditions where clinicians performed their diagnostic work 16 27 28. In addition to applying our tool to assess elements of the diagnostic process, we collected data on time physicians took for encounters as well as perceptions of time adequacy and work conditions by querying them regarding the time they felt was required for specific patient encounters.…”

Developing LHS scholars’ competency around reducing burnout and moral injury

“…An LHS aspires to improve the health of individuals and populations, generating and sharing knowledge to allow clinicians to apply best practices and make better decisions. Preventing burnout and moral injury is essential to this process, 16 as the ability to sustain as an HCW and make good decisions depend upon the health of the HCW. Burnout and moral injury prevention support LHS frameworks and core values as they:…”

“…An LHS aspires to improve the health of individuals and populations, generating and sharing knowledge to allow clinicians to apply best practices and make better decisions. Preventing burnout and moral injury is essential to this process, 16 as the ability to sustain as an HCW and make good decisions depend upon the health of the HCW. Burnout and moral injury prevention support LHS frameworks and core values as they: Nurture individual healthcare providers (person‐focused) Provide for a diverse workforce with diverse patients (inclusive) Allow HCWs to respond to urgent needs (adaptability) Provide substance for trust building (governance‐oriented) Allow leaders to rise to the top of their capabilities (participatory leadership) Allow capacity for incorporating rigorous new knowledge (scientific integrity), and Support HCWs in optimizing quality and moderating costs (value). …”