Expert opinions on Patient Safety Week

What does «Diagnosis. A team affair.»?

Making a diagnosis is always a team effort. In simpler situations, at least the patient and the responsible doctor are involved. In more complex situations, various medical specialists and other carers and family members may be involved in making a diagnosis.
When planning and administering anaesthesia, it is essential that the patient's diagnosis(es) are known so that optimal anaesthesiological care can be provided.

Specialist in anaesthesiology & attending physician, Swiss Medical Network

Various players must coordinate their efforts to achieve a better diagnosis.

Patient, Swiss Medical Network

Interprofessional collaboration is crucial for every patient. It requires good communication, respect and cross-professional interest. On the day of the appointment, the patient has communicated certain information to his attending physician. When he comes to the radiology department for the examination, some of this information may have been clarified, changed or reinforced. With my questions as a specialist, I try to explain the examination requests in detail if necessary (history, onset of symptoms, development to date, ongoing treatment). This gives us additional information, which we pass on to the radiologist. The radiologist can better link the images he analyses with the patient's symptoms. The radiologist visits the radiology centre regularly to talk to the patient. This enables him to refine his diagnosis by correlating the images with the patient's symptoms. Good interprofessional communication is therefore required so that as much information as possible can be passed on throughout the patient's course. I am also talking about respect and interest between professional groups, as each professional group must be able to anticipate the needs of another professional group and it is not always obvious what might be interesting or essential for these colleagues in patient care. The Vis-ma-vie that has been introduced in the clinic is very useful in the sense that we have the opportunity to get to know another profession and get an idea of their everyday life and needs.

Head of Radiology Department, Swiss Medical Network

Diagnostics is always a team affair. It is an analytical assessment of the nature of a possible disease. Therefore, all information is essential and useful for the diagnosis. Multidisciplinary co-operation is essential!

Regional Directorate, Swiss Medical Network

Diagnosis is the interpretation of signs and symptoms in order to recognise a clinical condition or pathology. Several professionals are involved in carrying out these processes: in obstetrics in particular, the gynaecologist, who assesses the course of the pregnancy and determines whether it is physiological or at risk, the obstetrician, who diagnoses the onset of labour based on the obstetric examination and cardiotocographic evaluation, the anaesthetist, who intervenes if the woman has haemodynamic problems or requests labour analgesia.
This means that it is very important to work in an interdisciplinary way to ensure effective care and to personalise each treatment as much as possible, always in accordance with international protocols.

Head of Family Department, Swiss Medical Network

There are three dimensions to healthcare: Diagnosis, prognosis and therapy. In my opinion, the communication channels between the various parties involved must be promoted and these three dimensions taken into account so that the statement ‘Diagnosis. A team effort’ is true. The different people involved have different skills and sensitivities to contribute to an accurate diagnosis.
 

Head of Physiotherapy Department, Swiss Medical Network

How do you feel about the co-operation between the various professional groups when making a diagnosis in your institution?
 

In the case of inpatients who require an X-ray examination, the surgeon caring for the patient informs the patient and the responsible nurse and then usually calls the radiologist to provide information about the procedure performed, the complications, the patient's symptoms and blood values and the suspected diseases. The surgeon fills out an examination order, which the radiology specialists receive by e-mail. The radiologist sends the information received and the protocol to the radiology specialists of the chosen imaging modality. The radiology specialists call the department to organise the examination with the nurse responsible for the patient. A specialist calls the transporter and informs them of the examination that the patient is to undergo or when this examination is scheduled in the radiology department. Once the examination has been carried out, the radiologist calls the surgeon to inform him of the initial results. He then writes a full report on our internal radiology computer system. The results are then transferred to the hospital information system so that the nursing staff and other healthcare professionals responsible for the patient have access to the diagnosis. The surgeon informs the patient about the diagnosis of the examination and further treatment.

Head of Radiology Department, Swiss Medical Network

Exchange of information between the various professional groups and coordination of the implementation of the defined treatment process.

Regional Directorate, Swiss Medical Network

The patient's initial diagnosis is entered on the registration letter sent by the sending doctor and completed by the nursing team during the initial anamnesis.
Information about the patient's follow-up that may have an impact on the initial diagnosis is passed on to the multidisciplinary team on a daily basis and enables treatment to be adapted.
The role of the nursing team remains central in the transmission of information by coordinating the various parties involved, especially when external persons are involved, and by participating in the medical visit at the patient's bedside.

Nurse, Swiss Medical Network

How can patients and their relatives contribute to finding a diagnosis?
 

Patients should document their symptoms and the progression over time in writing. This makes it easier for the family doctor or specialist to find the correct diagnosis more quickly by taking a more precise medical history. Discussions with relatives can also help. Relatives may observe the situation differently. They should also be consulted. Any therapies that have already been carried out should also be mentioned. Any secondary diagnoses, allergies, operations and medication should be disclosed.

Specialist in orthopaedics and traumatology FMH & attending physician, Swiss Medical Network

Patients can also come to a consultation prepared. As a specialist, I am dependent on having available clarifications, reports and findings, as - unlike a GP - I do not usually look after patients for years and therefore need to get to know them first. Relatives often complement the conversation well; they are sometimes more open when describing the symptoms of their loved ones than the patients themselves are.

Specialist in neurosurgery FMH & attending physician, Swiss Medical Network

In my opinion, the patient should communicate all the facts and elements that can point the doctor to the diagnosis. They must also accept and trust the proposed examinations.

Nurse, Swiss Medical Network

The patient tells the gynaecologist or midwife about the signs and symptoms she has noticed during pregnancy, while family members share their personal experiences and support her in taking the medical history.
Before the birth, the patient then has the opportunity to meet with a midwife for a pre-birth consultation to discuss the birth plan, i.e. the woman's and couple's wishes regarding the birth of their baby and the following days in hospital.
 

Head of Family Department, Swiss Medical Network

Keep a written record with the exact date. This should document the symptoms as well as the progression of the symptoms and the type (e.g. stabbing pain, throbbing pain); the intensity of the pain on a pain scale between 0 and 10 should also be documented. If you have already carried out a treatment on your own, describe it exactly and its effect as well as the period of time. What has a positive or negative effect on the symptoms (e.g. heat/cold).
Ideally, the patient should bring a list of secondary diagnoses, treatments (operations) and current medication.

Specialist in orthopaedics and traumatology FMH & affiliated doctors, Swiss Medical Network

To prepare well for your consultation, it is helpful if you take existing medical documents (reports of investigations, results of examinations and others) with you. It is also good if you think about your questions in advance or even write them down. Sometimes it is also desirable to be accompanied by someone close to you.

Specialist in anaesthesiology & attending physician, Swiss Medical Network

As a healthcare professional, what measures do you take to actively involve patients in the diagnostic process?
 

Our practice asks patients to submit their documents as completely as possible in advance. In an environment of increasingly strict data protection regulations, this is sometimes difficult for us. I also like to ask patients for their own ideas about what they think is the reason for their symptoms. Time for these things is the most valuable prerequisite on the way to a correct diagnosis.

Specialist in neurosurgery FMH & attending physician, Swiss Medical Network

The patient is first involved through preparation in the antenatal course, where she gains awareness and knowledge about pregnancy and birth. She then has the opportunity to have a discussion with a midwife, during which her medical history and her wishes regarding labour and birth are collected, which are then included in the birth plan. The patient is also offered the opportunity to take part in a discussion with the anaesthetist in order to make an informed decision about pain-relieving delivery.
 

Head of Family Department, Swiss Medical Network

The anamnesis of the first treatment and the anamnesis of the other treatment appointments enable me to focus my questions in such a way that I can probe the patient's answers and motivate them to clarify their perceptions so that they can be objectified.

Head of Physiotherapy Department, Swiss Medical Network