Eight Steps to Empowering Patients in the Diagnostic Process

In this era of consumerism, patients are taking a more active role in their healthcare and expect increased transparency and access to make decisions relating to their health.

As healthcare delivery continues to move towards value-based reimbursement, physicians are required to think and work differently. Physicians must listen to their patients to ensure they provide the highest quality of care centered on their individual needs and preferences. This starts at the very beginning: getting the diagnosis right.

To do so, physicians must effectively communicate and build partnerships with their patients and expect equal participation. These eight steps are designed to help physicians empower patients to get involved in the diagnostic process from the moment they first meet.

1. Ask for their whole story. Studies have shown that more than 80 percent of diagnoses can be made based on history alone. Instead of asking a series of questions focused solely on the chief complaint for their visit, take the time to learn more about their health history. This will uncover more than simple "yes/no" answers and provide you with a bigger picture for the diagnosis.

2. Make sure you're on the same page. After patients recount their history, tell them what you're thinking and make sure you're on the same wavelength. This is a crucial part of developing the partnership.

3. Encourage patients to participate in their physical exam. Explain to patients what you're looking for during a physical exam and encourage them to ask questions or voice concerns about any of the findings.

4. Make a differential diagnosis together. Work with patients to come up with a thorough list of possible diagnoses that could explain their symptoms, with some estimate of the likelihood of each potential.

5. Partner in the decision-making process. Devise a strategy with patients for narrowing down the list of possible diagnoses. By partnering with your patients, you can often arrive at a working diagnosis without a lot of tests.

6. Apply tests rationally. If patients do require further testing, they should understand how a particular test will help narrow the differential and any risks or alternatives. Tailor an approach that works for the individual patient.

7. Ensure patients are comfortable with the diagnosis. Patients shouldn't leave your office feeling uncertain about a diagnosis. Take the time to make sure they understand the diagnosis and its implications.

8. Explain how to integrate the diagnosis into the healing process. Talk through the diagnosis with patients and make sure they understand its predicted course, including treatment options, risks, and benefits. And if the working diagnosis turns out to be wrong, give them signs they should look out for.

In the end, it's up to patients to take an active role in their health care, but physicians have an opportunity to become advocates for their patients to ensure they receive the highest quality care, starting with the right diagnosis. 

Josh Kosowsky, MD, FACEP, is an emergency physician coach at Studer Group and director for patient experience and provider engagement at Brigham & Women's Hospital.