Diagnostic Gaps Between Doctors and Patients: Why It’s So Difficult To Get the Right Care

The majority of doctors have very little training in diagnosis. They often lack confidence in their diagnostic skills, particularly with respect to certain conditions. Some factors contribute to this. First, training in diagnosis is poor, even within medical schools. Second, diagnostic skills are often taught as part of the “clinical” curriculum rather than in a separate, dedicated course. Third, there is too much emphasis placed on treating symptoms rather than on understanding the disease. Fourth, there is insufficient emphasis on teaching doctors how to identify the most appropriate tests or examinations to make an accurate diagnosis. Fifth, the cost of diagnostic tests is often prohibitive for patients. Sixth, patient education programs are rarely designed to improve diagnostic skills. 

Diagnostic gaps, the step in the treatment cascade that identifies the illness, is essential. A person diagnosed with a disease can then be treated with drugs, surgery, or other interventions. But getting a diagnosis right is hard. It is estimated that only a third of people who have symptoms suggestive of a disease get an accurate diagnosis, and even fewer people are diagnosed in a timely way. Diagnosis, therefore, is the weakest link in the cascade of care. In 2014, more than one in five people had no medical insurance; in addition, only about half of the people living with HIV/AIDS were receiving treatment. There is therefore a pressing need to improve access to diagnostic services.

Diagnostic capacity is important to ensure the delivery of quality care—after all, we must identify a disease before we can effectively treat it. The diagnostic capacity of a health care system is, therefore, a critical factor in the achievement of universal health coverage, which relies upon the detection of large numbers of people with treatable conditions.

Large gaps at the diagnosis stage exist for key diseases, including tuberculosis, diabetes, hepatitis C, and hypertension, leaving many people undiagnosed. They often lack confidence in their diagnostic skills, particularly with respect to certain conditions. Some factors contribute to this. First, training in diagnosis is poor, even within medical schools. Second, diagnostic skills are often taught as part of the “clinical” curriculum rather than in a separate, dedicated course.

There is too much emphasis placed on treating symptoms rather than on understanding the disease. Third, there is insufficient emphasis on teaching doctors how to identify the most appropriate tests or examinations to make an accurate diagnosis. Fourth, the cost of diagnostic tests is often prohibitive for patients. Fifth, patient education programs are rarely designed to improve diagnostic skills.  A result is a large number of people who have not been diagnosed, despite presenting with signs and symptoms indicative of a treatable condition.

An important step towards increasing access to diagnosis is to improve the quality of training for doctors and other health workers. But it’s not enough just to train the current workforce: we must also invest in the capacity of the existing health system. For example, the cost of running a laboratory is often beyond the reach of most people.

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