Diagnostic excellence refers to an optimal process to obtain an accurate explanation of a patient's condition. This process usually begins when a patient experiences a symptom or a problem and seeks care, followed by iterative information gathering, integration, and interpretation to arrive at a working diagnosis. A manuscript published in the November 2023 issue of the journal Patient Education and Counseling points out that this diagnostic process includes collaboration and co-creation of the working diagnosis and diagnostic plan by patients, caregivers and clinicians. Evidence supports the importance of engaging patients and their caregivers to improve clinical outcomes and the safety of the diagnostic process. Yet, most improvement has focused on the role of patients as a source of information and assuring adequate delivery of diagnostic information to patients, more than including patients in the process through active collaboration. Diagnostic errors are defined as a "failure to establish an accurate and timely explanation of the patient's health problem or communicate that explanation to the patient.” This definition highlights diagnosis as a process. It emphasizes the importance of adequate communication between clinicians and patients.
Nonetheless, in a systematic review of 16 studies evaluating diagnostic errors, only four investigations evaluated the "communication" component of the diagnostic error definition. Communication between patients and clinicians is central in diagnostic conversations as it allows a) patients’ presentation of their symptoms that guide subsequent diagnostic steps, b) negotiation of the significance of the patients’ symptoms through conversation, and c) introducing and resolving diagnostic uncertainty. Overall studies highlighted different activities that patients and clinicians complete during the diagnostic visit that potentially could serve as barriers (e.g., not understanding the significance of the patients’ symptoms) or facilitators (e.g., discussing diagnostic uncertainty) to diagnostic excellence. Lack of agreement on the importance of a problem between patient and clinicians can have negative consequences such as loss of trust, non-attendance to follow up visits or non-completion of diagnostic tests. Patient and clinicians also should cooperate when developing the diagnostic plan and consider not only the perceive benefit of a test, but the patient effort required to implement the diagnostic plan.