The foundations of the diagnostic error movement: a tribute to Eta Berner, PhD

Mark L. Graber

doi:10.1515/dx-2024-0182

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The foundations of the diagnostic error movement: a tribute to Eta Berner, PhD

Mark L. Graber

Published/Copyright: December 10, 2024

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From the journal Diagnosis Volume 12 Issue 2

Although papers on diagnostic error had appeared earlier, the current movement to address diagnostic error got its start at a conference Pat Croskerry hosted at Dalhousie University in 2005 on clinical reasoning, which included Charles Vincent, Bob Wears, and other luminaries. I had attended several of the early NPSF meetings on patient safety, and attended Pat’s meeting to see if there was any connection, and indeed there was: the problem of diagnostic error. In discussing this with Eta Berner, a PhD colleague at the University of Alabama, she mentioned her connection to Paul Mongerson, the CEO of Stanadyne, a Fortune 500 company (Moen faucets, etc.), who was told in 1980 that he had advanced pancreatic cancer and only a few months to live. It turned out he did not have pancreatic cancer; this was a diagnostic error. As an engineer he couldn’t understand how things like this could happen, and through philanthropic donations he supported several efforts to improve diagnosis in health care, including support for the informatics department at Vanderbilt to help them build an electronic medical record, and decision support functionality.

Paul agreed to host a meeting at his home in Naples, Fl, and in the winter of 2005 a small group met there to talk about diagnostic error and what could be done about it. The attendees were Pat Croskerry, Eta Berner, Gordy Schiff, Jenny Rudolf, Beth Crandall (of Gary Klein Associates), Bob Wears, and Mark Graber. Two key decisions were made at this meeting:.

To solicit and publish a collection of papers on diagnostic error. This was published as a special issue of the American Journal of Medicine later in 2008 (Figure 1) [1], supported financially by Mr. Mongerson, who wrote the introduction to the special issue [2].
To host a conference on diagnostic error. With support from AHRQ, this first “DEM”, Diagnostic Error in Medicine conference was held in 2008 in Phoenix, attended by 127 clinicians, researchers, and several patients (Figures 2 and 3). Eta co-chaired the meeting with me, and arranged with AMIA (the American Medical Informatics Association) to allow us to share some of their conference space. The proceedings of the conference were published as a special issue of Advances in Health Sciences Education (Vol 14, Issue 1, Supplement; Sept 2009) (Figure 4). The “DEM” meeting has been held annually every year since 2008, sponsored by The Society to Improve Diagnosis in Medicine, and has served as a home for the interdisciplinary group of clinicians, researchers, educators, health safety professionals, administrators and patients interested in improving the safety and quality of diagnosis.

Figure 1:

The 2008 issue of the American Journal of Medicine dedicated to diagnostic error, Eta Berner co-Editor.

Figure 2:

The program cover for the first “Diagnostic Error in Medicine” conference, 2008.

Figure 3:

Attending the first DEM meeting: Pat Croskerry, Carmel Crock. Eta Berner, Gordy Schiff, and Mark L. Graber (at The Claim Jumper Restaurant, Phoenix AZ, 2008).

Figure 4:

The 2009 supplement to Volume 13, Issue 1 of Advances in Health Sciences Education: “Diagnostic Error in Medicine”. Eta Berner, co-Editor.

Paul Mongerson passed away in 2015; Bob Wears, who made many important contributions to patient safety and the role of human factors (his publications have over 20,000 citations) passed away in 2017.

Eta Berner passed this past December, 2023. Her obituary details her many contributions as a faculty member for over 25 years at the University of Alabama in the Health Informatics program, and to the field of medical informatics [3]. She authored over 100 papers and four books, many of them focused on clinical decision support and on the impact of electronic medical record systems. Eta was a Fellow of the American College of Medical Informatics, the Healthcare Information and Management Systems Society, and the International Academy of Health Sciences Informatics. As a very appropriate tribute to her contributions in the field, the very first case scenarios she constructed to test early decision support programs, over 30 years ago, were recently used in a randomized control trial to test the power of large language models to improve clinical reasoning [4].

Her keen interest in decision support, and the resulting connections to Paul Mongerson and AMIA were therefore the magic ingredients that enabled our first conference, which catalyzed the ultimate formation of SIDM. Eta thus played a foundational role in two highly-related fields that have grown substantially over the ensuing decades: the movement to address diagnostic safety and quality, and the field of health informatics and clinical decision support.

Corresponding author: Mark L Graber, MD, CIDM, 5 Hitching Post, Plymouth, Massachusetts 02360, USA, E-mail: graber.mark@gmail.com

Research ethics: Not applicable.
Informed consent: Not applicable.
Author contributions: The author has accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The author states no conflict of interest.
Research funding: None declared.
Data availablility: Not applicable.

References

1. Berner, E, Graber, M. Overconfidence as a cause of diagnostic error in medicine. Am J Med 2008;121:S2–23. https://doi.org/10.1016/j.amjmed.2008.01.001.Search in Google Scholar PubMed

2. Adler, KG. Web portals in primary care: an evaluation of patient readiness and willingness to pay for online services. J Med Internet Res 2006;8:e26. https://doi.org/10.2196/jmir.8.4.e26.Search in Google Scholar PubMed PubMed Central

3. Storr, K. Mourning the passing of University professor Eta Berner. University of Alabama at Birminghag; News – School of the Health Professions; 2023.Search in Google Scholar

4. Abidi, SS, Goh, A. A personalised Healthcare Information Delivery System: pushing customised healthcare information over the WWW. Stud Health Technol Inf 2000;77:663–7.Search in Google Scholar

Received: 2024-11-04

Accepted: 2024-11-06

Published Online: 2024-12-10

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https://doi.org/10.1515/dx-2024-0182