Diagnostic Accuracy For Patient Safety

World Patient Safety Day was observed globally on September 17 as an essential occasion to spotlight the importance of patient safety within healthcare systems. Since its inception in 2019 by the 72nd World Health Assembly, this day has served as a global platform to advocate for better safety measures in healthcare practices. The theme for World Patient Safety Day 2024 was "Enhancing Diagnostic Accuracy for Patient Safety," accompanied by the powerful slogan, "Get it right, make it safe!" This theme emphasises the need for accurate and timely diagnoses, a critical element in ensuring patient well-being and preventing unnecessary harm.

Diagnostic safety lies at the heart of effective healthcare. A correct and timely diagnosis forms the foundation for appropriate treatment and optimal outcomes. Diagnostic errors, whether in the form of delayed diagnoses, missed diagnoses, or incorrect diagnoses, can have life-threatening consequences. These errors often result in delays in treatment, prolonged suffering, and in the worst cases, preventable deaths. In resource-limited countries like Nepal, where healthcare infrastructure is often underdeveloped, the stakes are even higher. Misdiagnoses or delays in diagnosis can exacerbate conditions, making them harder to treat, and can significantly increase the financial and emotional burden on patients and their families.

Diagnostic safety

Globally, diagnostic safety has garnered increased attention in recent years, as reflected in the WHO's Global Patient Safety Action Plan 2021–2030. This action plan outlines specific goals aimed at improving the accuracy of diagnoses in healthcare systems worldwide. World Patient Safety Day serves as a platform to raise awareness on these issues and promote action to address the root causes of diagnostic errors.

Nepal faces unique challenges when it comes to healthcare delivery. The country's rugged terrain and remote communities make it difficult for many people to access healthcare services, let alone specialised diagnostic facilities. In rural and mountainous areas, primary healthcare centres and health posts often lack necessary diagnostic equipment, forcing patients to travel long distances to district hospitals or tertiary care centers. For many, these journeys are not only physically taxing but also financially burdensome.  Even in urban areas, diagnostic challenges persist due to resource constraints, overburdened healthcare providers, and outdated equipment. As a result, patients often experience delays in receiving an accurate diagnosis, which can be particularly dangerous for conditions such as tuberculosis, cancer, and maternal health issues. 

Moreover, Nepal's healthcare system is challenged by a shortage of trained healthcare professionals, particularly in rural areas. Overburdened healthcare workers, who may not have access to advanced diagnostic tools or specialists, often struggle to identify and diagnose complex conditions. This situation is further compounded by the lack of continuing medical education and training for healthcare providers, which limits their ability to keep up with the latest developments in diagnostic techniques and technologies.

In addition to structural challenges, Nepal’s diverse linguistic and cultural landscape complicates the diagnostic safety. With over 120 languages spoken across the country, effective communication between healthcare providers and patients can be difficult, particularly in remote areas. In many cases, patients may not fully understand the information given to them by healthcare workers, which can result in confusion or misinterpretation of symptoms. Similarly, healthcare providers may struggle to fully grasp the severity or nature of a patient's condition due to language barriers, leading to misdiagnoses or delays in treatment. Cultural factors also play a significant role. In some communities, health-seeking behaviour is influenced by traditional beliefs and practices, which can delay the presentation of symptoms to healthcare providers. By the time patients seek medical attention, their conditions may have worsened. Such barriers must be addressed through targeted interventions, such as the training of healthcare providers in cultural competence and the use of medical interpreters.

Cost of errors 

Diagnostic errors are not just a matter of patient safety; they also have significant economic implications. For patients and families, the financial burden of delayed or incorrect diagnoses can be overwhelming. In many cases, diagnostic errors result in prolonged treatment, repeated tests, and unnecessary procedures, all of which increase healthcare costs. For the healthcare system, these errors lead to inefficiencies and resource wastage, further straining an already overstretched system.

In Nepal, the cost of diagnostic errors is particularly high for vulnerable populations, such as women, children, and marginalised communities. These groups often face barriers to access healthcare, and when they do receive care, they are more likely to experience diagnostic errors due to factors such as lower health literacy, limited access to specialists, and inadequate diagnostic facilities in rural areas. 

Improving diagnostic safety requires a comprehensive approach that addresses both systemic and local challenges. Investments in healthcare infrastructure, particularly in rural areas, are critical to improving diagnostic accuracy. Health posts and primary healthcare centers must be equipped with essential diagnostic tools, and district hospitals should have the capacity to handle more complex cases. Mobile diagnostic units could also be deployed to reach remote areas, reducing the need for patients to travel long distances.  The shortage of trained healthcare professionals is a major contributor to diagnostic errors. Expanding training programmes for healthcare providers, with a focus on diagnostic skills and the use of new technologies, is essential. Medical education should be prioritised to ensure that healthcare workers stay updated on the latest diagnostic techniques and protocols. 

Encouraging patients to take an active role in their healthcare process is critical to improving diagnostic accuracy. Patients should be empowered to ask questions, seek second opinions, and participate in decisions regarding their diagnosis and treatment. In Nepal, where health literacy levels vary, public health campaigns that promote awareness of common symptoms and the importance of seeking timely medical care could have a significant impact.  Language and cultural barriers must be addressed to ensure that all patients receive accurate diagnoses. This could be achieved by training healthcare providers in cultural competence and the use of medical interpreters. In areas with high linguistic diversity, healthcare materials should be made available in multiple languages to ensure that patients fully understand their diagnoses and treatment options. 

By prioritising diagnostic safety, Nepal can take significant steps toward ensuring that all citizens, regardless of their geographic location or socioeconomic status, receive the accurate and timely care they need.  The responsibility lies not only with healthcare providers but also with policymakers, patients, and communities. By working together to improve diagnostic infrastructure, enhance training, and empower patients, Nepal can reduce the incidence of diagnostic errors and move closer to a future where patient safety is at the forefront of healthcare delivery.

(The author is a patient rights activist associated with Patient Rights Concern Nepal.)