The Society to Improve Diagnosis in Medicine’s legacy: building a foundation for diagnostic excellence

1. Raising awareness: make improving diagnosis a priority for healthcare

SIDM employed diverse strategies to raise awareness of diagnostic error as a problem. These included the annual SIDM DEM conferences, which have now spread to Alaska (Shawn Vanio), and internationally to Australia (Carmel Crock), Europe (Laura Zwaan, Maarten ten-Berg, Wolf Hautz), and most recently Japan (Taro Shimizu). Other channels included hosting a dedicated listserv discussion group, and establishing an official journal of the Society (Diagnosis, published by De Gruyter Brill). Susan Carr published a highly informative newsletter on a quarterly basis. The SIDM website became the go-to resource for diagnosis-related news and events.

Two additional projects were central to raising awareness:

Recognition by ECRI (formerly the Emergency Care Research Institute) and the World Health Organization (WHO)

SIDM’s efforts to raise awareness had impact. The number of individuals in the US aware of and concerned about diagnostic error likely increased from several dozen in 2008 to tens of thousands by 2020. The most noteworthy measure of impact came in 2018 when ECRI designated diagnostic error as ‘The #1 patient safety concern’ in healthcare [13] (Figures 2 and 3). Diagnostic error made ECRI’s top-10 list several more times in subsequent years. In 2024, the WHO designated diagnostic error as the focus of its annual World Patient Safety Day (Figure 4), evidence that recognition of diagnostic error had become international in scope. The World Patient Safety Day slogan was “Get it right, make it safe!”, emphasising the critical role of correct and timely diagnosis in improving patient safety worldwide [14].

Figure 2:

Recognition of diagnostic error by ECRI in 2018.

Figure 3:

Recognition of diagnostic error by ECRI in 2018.

Figure 4:

Recognition of diagnostic error by the WHO for World Patient Safety Day in 2024.

2. Research: increase investigations on diagnosis and focus on diagnostic outcomes that matter to patients

The academic literature on diagnostic error increased appreciably between 2005 and 2025, reflecting growing interest in the topic generally, and the rising number of investigators funded to conduct formal research.

Progress was focused in two areas:

Assessing the magnitude of the problem: The 2015 NASEM report [3] concluded that one in 10 diagnoses were probably wrong, and that the harm associated with these errors accounted for 40,000 to 80,000 lives lost annually. The report famously concluded that “It is likely that most of us will experience a diagnostic error in our lifetime, sometimes with devastating consequences”. Subsequent studies have concluded that disabling harm and deaths related to diagnosis may actually be 10 to 20 times higher [15], clearly placing diagnostic error among the top-10 causes of death in the US annually.

Understanding the origins of diagnostic error: The 2015 NASEM report [3] provided great insights into the factors that contribute to diagnostic error. These factors are many and diverse, but primarily fall into two large areas: (1) factors inherent to the healthcare system, and (2) cognitive factors that affect diagnostic accuracy by an individual clinician. More recently, attention has advanced to understanding the interplay between these elements as dictated by the care context, and how human factors influence decision-making [16], 17]. Beyond studies focusing on diagnostic error as a general process failure, a growing number of research studies now address specific medical specialty and problem areas, such as stroke, cancer and sepsis [18].

SIDM’s Research Committee created opportunities to convene experts and emerging leaders, curated leading-edge research for presentation at the SIDM DEM conferences, and fostered a community of scholars who supported early-career researcher development. The Committee established an online repository of the then sparse literature on diagnostic error as a resource. Beginning in 2013, the Committee initiated annual research summits bringing together committee members and invited experts to engage in discussion, form collaborations, generate new ideas, and set research priorities. Many of the Committee’s major contributions to the field stemmed from the rich discussions at these annual summits and are now recognized as seminal papers in the field of diagnostic excellence. These papers provided guidance on advancing research in diagnostic error reduction [19], addressing challenges in defining and measuring diagnostic error [20], identifying research priorities for diagnostic safety [21], and evaluating strategies to reduce diagnostic error [22].

The Committee’s influence extended to broader academic discourse through members serving as editors, authors and reviewers for a landmark BMJ Quality and Safety supplement that summarized key SIDM presentations and discussions from 2010 to 2013. This supplement helped garner wider recognition of diagnostic safety research, set the imperative for studying and improving the diagnostic process [23], and ultimately informed the 2015 NASEM report [3].

The Committee consistently emphasized patient engagement, incorporating patient perspectives into research priorities and fostering patient-researcher collaborations [24]. To support researcher development, the Committee established virtual journal clubs and group meetings where researchers at all career stages could receive feedback on works in progress. Through active engagement of SIDM fellows in all aspects of its work, the Committee helped develop the next generation of scholars and thought leaders in diagnostic excellence. This mentorship has proved fruitful, with numerous SIDM fellows and early-career researchers publishing high-impact articles with the Committee’s support [25], [26], [27].

3. Education: transform education of health professionals to improve diagnosis and develop new leaders in diagnostic safety

Before the 2015 NASEM report [3], medical schools expected students to pick up the art of diagnosis passively by observing their teachers. No courses on diagnosis or explicit training on clinical reasoning existed. A 2015 national survey of internal medicine clerkship directors found that students at most schools had only poor (29 %) or fair (55 %) knowledge of key clinical reasoning concepts [28].

Fortunately, educators comprised a substantial fraction of SIDM’s professional membership. The SIDM Education Committee actively sought to improve diagnosis-related education through a wide range of projects, including special sessions, pre-conference workshops at the annual SIDM DEM conferences, and collaboration with the Research Committee to bring educators and researchers together in an annual summit to set priorities for research and education. Additionally, the Committee developed an international interdisciplinary faculty development course entitled TeachDx, which aimed to provide faculty with the knowledge and skills to become leaders in reasoning education at their own institutions. Partnerships were developed with professional societies, including the American College of Physicians and the Society of Hosptial Medicine to develop modules about diagnostic error for practicing clinicians. In addition, the Committee developed, in partnership with MedU (now Aquifer), the first-of-its kind virtual patient curriculum focused on diagnosis education. These modules have been used extensively in medical schools and other health professions education programs. SIDM members were also lead authors on new resources and tools for educators (notably the Assessment of Reasoning Toolkit [29]) and the SIDM website was an effective repository for these.

SIDM and its members secured a key grant from The Macy Foundation to develop and disseminate a Consensus Curriculum to Improve Diagnosis, which for the first time codified the competencies necessary for health professions education programs to develop in their learners [30]. The new competencies emphasized interprofessional training, working in teams, and the need to effectively work within health systems to improve diagnosis. Further, individual strategies such as hypothesis-driven data gathering, problem representation, differential diagnosis generation and justification, and appropriate use of diagnostic testing were emphasized, along with often under-addressed topics such as using decision support tools, getting second opinions, and using reflection. Similar guidance on improving diagnosis-related education soon followed for pharmacy [31], 32] and nursing trainees [33], [34], [35].

4. Practice improvement: engage patients, clinicians, and healthcare systems to improve current diagnostic performance and reduce harm from diagnostic error

Reducing harm from diagnostic error requires comprehensive systemic reform and continuous improvement in diagnostic practices. SIDM’s Practice Improvement Committee was a driving force in advancing this mission by fostering collaboration, supporting strategic initiatives, and facilitating practice enrichment through continuing education.

Through expert guidance, mentorship, and the dissemination of best practices, the Committee became a cornerstone of SIDM’s diagnostic improvement efforts. It also cultivated strategic partnerships within the organization, working closely with staff and stakeholders to maximize the impact of practice improvement initiatives. Additionally, committee members contributed to SIDM’s grantmaking programs by serving in an advisory capacity, helping to direct resources toward high-impact projects.

Beyond these core contributions, committee members played a vital role in advancing professional education, contributing to the planning and delivery of sessions at SIDM’s annual conference and volunteering their expertise during the abstract review process. Their commitment to cross-functional collaboration was further exemplified through joint efforts with other groups and committees, such as the 2019 Research/Practice Improvement Summit, which brought together diverse perspectives to address complex diagnostic challenges.

Among SIDM’s five strategic goals, practice improvement has proven the most challenging, though evidence of progress is emerging:

Sepsis: Early diagnosis significantly improves outcomes. Research has identified opportunities to recognize sepsis sooner, with guidelines, protocols, and early warning systems now in active use [36], 37].

Safe use of health informatics: The adoption of electronic health records introduced new risks related to diagnosis. The development and adoption of the SAFER Guides for Safe Use of Health IT have helped to successfully address many of these problems [38]. Singh’s research on test result communication and follow-up has shaped policy across the Veteran’s Affairs healthcare system [39], 40].

Cancer diagnosis: While early detection through screening improves outcomes, many patients miss screenings or fail to follow-up on positive results. A program aimed at following-up on patients with positive fecal occult blood tests has measurably increased colonoscopy completion rates [41].

5. Patient engagement: integrate patients and their families in all diagnostic improvement areas

Patient engagement was fundamental to SIDM’s mission. Both the SIDM Patient Engagement Committee, and later in SIDM’s tenure, dedicated patient engagement staff, worked to ensure patient engagement featured in every aspect of SIDM’s work. Even before SIDM was formally organized, Kathy McDonald, then president of the Society for Medical Decision Making, worked with a group of patients to raise awareness and improve patient participation in diagnosis. Patients and families directly affected by serious diagnostic error were powerful allies in raising awareness about the need for enhanced diagnostic safety, including accompanying SIDM leaders to Capitol Hill for briefings and lobbying efforts with US legislators. Patient insights and personal accounts of diagnostic error helped bridge the gap between abstract policy and the real-world consequences of diagnostic error and humanized the issue, providing evidence for policymakers and engaged legislators.

The SIDM Patient Engagement Committee was organized in 2013. Beginning in 2014, the Committee organized patient summits on diagnosis held in conjunction with the SIDM annual conferences, with diverse themes ranging from practical diagnosis guidance to health equity and diagnostic practice co-design. Along with SIDM’s patient engagement team, the Committee advocated for greater patient and family engagement in the conferences, including patient plenary speakers, patient panels, patient commenters in every session, and a dedicated patient and family poster track. The Committee’s key achievements included developing The Patient’s Toolkit for Diagnosis to help patients prepare for medical appointments [42], and StoryBank, a collection of first-hand accounts of experiences with diagnostic error to educate and promote awareness of diagnostic error. These resources lived on the SIDM website, along with a novel Ask the Librarian page where patients could pose questions to a research librarian. Committee members contributed to diagnostic safety research, including through reviewing the 2015 NASEM report [3], national and international conference presentations, and serving on committees, including diagnostic measurement development committees and the steering committee for the WHO’s diagnosis-themed World Patient Safety Day 2024 [14]. Committee member Helene Epstein regularly published the widely disseminated Dx IQ column to educate patients and families about diagnostic safety issues and scholarship.

Based on input from patients at the 2012 DEM conference, McDonald, Cindy Bryce, and Graber laid out an ambitious plan for patient engagement research in diagnosis [43]. Much of this work has been achieved as patient engagement has evolved into a thriving branch of diagnostic research. Projects specifically organized by the SIDM patient engagement team, and often in partnership with the Committee, focused on promoting patient and family engagement in diagnostic safety research [44], [45], [46], and Patient Family Advisory Councils [47], eliciting recommendations on diagnosis from a “citizen jury” [48], developing patient research methodologies [49], and collaborating on research initiatives to address critical diagnostic challenges, including telediagnosis [50], disparities in diagnosis related to race, ethnicity and gender [51], disparities solutions [52], and missed and delayed diagnosis of women’s heart disease [53]. In addition, SIDM’s DxQI Seed Grant Program, which aimed to engage healthcare organizations to improve diagnostic quality, required applicants to incorporate patient engagement into their proposals and included patient engagement training for applicants and awardees and patient reviewers.

The Patient Engagement Committee continues to meet and plan, representing one of SIDM’s most enduring and impactful legacies.