Getting it Wrong

Though some employers are helping to bring "one-size-fits-all" healthcare to a necessary end by tackling misdiagnosis in the workplace, they still don't go far enough. Meanwhile, one solution -- clinical integration -- is appearing on the corporate radar.

Tuesday, November 27, 2012
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Misdiagnosis has become a public health crisis.

This may seem like an alarmist statement, given that we live in an age of such great medical advances, but it's true. Despite the latest and greatest medical technology and procedures, at least 15 percent of patients still get the wrong diagnosis, according to "Overconfidence as a Cause of Diagnostic Error in Medicine" in The American Journal of Medicine. In addition, a Mayo Clinic Proceedings study, "Comparison of Premortem Clinical Diagnoses in Critically Ill Patients and Subsequent Autopsy Findings," found 26 of 100 patients who died in the hospital had been misdiagnosed, while -- according to "Views of Practicing Physicians and the Public on Medical Errors" in The New England Journal of Medicine -- even doctors are not immune to misdiagnosis: Thirty-five percent of doctors report errors in their own care or that of a family member.

It's a problem that costs lives and causes needless suffering. Added to this, according to Drs. David E. Newman-Toker's and Peter J. Pronovost's article in the Journal of the American Medical Association, "Diagnostic Errors: The Next Frontier for Patient Safety," nearly one-third of the roughly $2.7 trillion spent each year on healthcare in the United States is considered to be wasted dollars -- many of which are tied to misdiagnosis and medical error.

The human toll of misdiagnosis is tremendous. It deprives patients of needed care and exposes them to the side-effects of inappropriate treatment. It generates untold expenses from incorrect treatment, surgeries and prescriptions, and can often mean deadly consequences when a condition goes undiagnosed and gets worse.

So, how can so many misdiagnoses still be happening?

For a number of reasons, foremost among them an overburdened, fragmented healthcare system. The bottom line is it's hard to deliver high-quality care in a system in which doctors don't have enough time with -- and information about -- their patients.

The good news is corporate America is not waiting around for government to provide every answer to healthcare's complex challenges. Many companies across the country have implemented a wide array of care-management, wellness, disease-management and other programs designed to help employees get well and stay well.

The challenge, however, is data showing that even many of the best-designed workplace programs don't go far enough to address the core underlying problems in our healthcare system. As a result, in spite of progress being made by U.S. companies, misdiagnosis unfortunately remains a major workplace problem -- resulting in absent workers, poor health outcomes, wasted healthcare dollars, decreased productivity, and increased health and disability premiums.

Clinical Integration

It doesn't have to be this way.

Many of the country's leading employers have shown that, by integrating and collaborating with vendors' healthcare programs, they actually improve the quality of care their employees receive -- and positively impact their healthcare costs.

This innovative approach, attracting the attention of a growing number of businesses and organizations, is called "clinical integration." In the last year alone, my company, Boston-based Best Doctors, Inc., has helped more than 20 Fortune 500 companies, including PepsiCo and EMC Corp., transition to this method, integrating with more than 200 vendors. This streamlined process means coordinating care to Best Doctors' expert physicians, but, importantly, back out to companies' other care-management partners as well.

Clinical integration streamlines the many health benefits offered to employees, maximizes each one and enables employers to create a much more personalized, cost-effective employee-healthcare experience. By doing this, these companies have been better able to target individual employees' health needs with the right health services, grow vendor accountability and improve how employees experience their own healthcare.

So how does it work?

Employers using clinical integration urge all of their healthcare vendors -- from disability, specialty pharmacy programs and health-plan care managers to disease management and wellness partners -- to work together to make sure each employee in their program gets the right diagnosis and treatment. By ensuring this is the case, a company like Best Doctors is then able to ensure employees are in the most appropriate healthcare programs for their needs.

The power of clinical integration is it enables employers to make the most efficient use of their existing, valuable benefit offerings. It takes the guesswork out of whether employees are in the right programs, and gives employers and employees alike the confidence that they are on the right path to getting well and staying well. It also helps employers better communicate to their employees the useful services available to them -- while impacting costs more positively.

Adopting clinical integration sends a clear message to a company's healthcare vendors that there is no longer room for an overly simplified, one-size-fits-all patient approach in healthcare. Vendors must be accountable for ensuring every single employee gets the right resources based on his or her particular condition. Importantly, this more patient-centric process takes advantage of the fact that employees are individuals, each with their own particular needs. This approach, both pro-employer and pro-employee, benefits everyone.

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Empowering Employees

A company's work to improve the health of its employees doesn't end with an approach like clinical integration. While the concept is a key element in improving healthcare quality and communication with vendors, it is just one important piece of the puzzle. The other is equipping employees with information and advice so they can more actively impact, and take greater control over, their own care. They can learn to reduce their chances of being misdiagnosed, and to seek the right care -- not just more care.

Employers likely will find it helpful to share with employees these steps to help them make their way through the often-muddled healthcare maze most of us face when we get sick:

* Don't be shy. Be curious and insistent. Ask your doctor questions about your diagnosis and treatment. Ask things such as, "What else could this be?" Keep asking questions every step of the way until you're satisfied with the answers.

* Get a second opinion. But don't show up and tell the next doctor, "I've been diagnosed with this type of illness; what do you think?" Instead, focus on telling the doctor all of your symptoms. Don't guide his or her thinking according to what the first doctor said. As Dr. Jerome Groopman writes in his classic book, How Doctors Think, "telling the story again may help the physician register some clue that was, in fact, said the first time but was overlooked or thought unimportant."

* Take the time to get to know your family medical history, and make sure your doctor knows about it. Studies show your family history may tell you more about what kinds of illnesses you may have or are likely to get than even genetic testing. If you search for My Family Health Portrait on Google you'll find a handy online tool from the U.S. Surgeon General to help you assemble your own family medical history.

* Take someone with you to doctor's visits. It's hard to listen to difficult medical news and pay attention to all the details at the same time. Bring along a friend or family member to remind you of questions you want to ask, and to help you write down important notes.

* Have your pathology rechecked. If you had a biopsy and your diagnosis is based on your pathology report, try to get it reviewed again. Pathology is incorrectly interpreted more often than commonly thought. If that interpretation is wrong, your diagnosis -- and your treatment -- probably are going to be wrong, too.

An approach such as clinical integration, together with clear communication with employees about taking charge of their own health and wellness, will make a great difference. Employers will keep their health benefits focused where they want them: on their individual employees. Importantly, they will create a healthier, happier, more productive workforce -- while making a positive financial impact in the process.

Evan Falchuk is vice chairman of Best Doctors, Inc., a Boston-based global health company. Send questions or comments about this feature to

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