Communicating for diagnostic excellence

Artwork: Marylouise Minehan; Photo: Martin Ollman.

About the program of work

Diagnostic errors are a common patient safety blindspot and often involve communication breakdowns. Uncertainty is ubiquitous in the diagnostic process. Clear, accurate and open communication is the linchpin to ensure correct, timely and safe care.

ICH Senior Research Fellow Dr Mary Dahm is conducting a program of research to show how language and communication can become powerful tools for diagnostic excellence.

Mary’s project Addressing the Challenge of Communicating Uncertainty in Diagnosis was awarded a Discovery Early Career Researcher Award (DECRA) from the Australian Research Council (ARC). This project (2022-2025) will examine the critical role and impact of communication on the diagnostic process in health settings. Expected outcomes include practical communication strategies, advanced research methods in misdiagnosis, and enhanced research capacity in the health community. Work on this prestigious grant commenced work in August 2022 and brings together the different scientific disciplines of linguistics, health communication, consumer engagement and diagnostic error, and a diverse team of stakeholders including clinicians, patient advocates and policy makers.

In collaboration with Dr Carmel Crock (Director Emergency Department, Royal Victorian Eye and Ear Hospital, Melbourne), Dr Dahm has published foundational journal articles and viewpoints on language in diagnosis and diagnostic uncertainty. This includes an invited viewpoint Understanding and Communicating Uncertainty in Achieving Diagnostic Excellence in the Journal of the American Medical Association (JAMA), and Diagnostic Statement: Linguistic Analysis of how Clinicians Communicate Diagnosis, the first academic work linking linguistic expressions and diagnostic accuracy which garnered national media attention. She has also led a systematic review with a team of clinicians and health consumer representative on the communication of diagnostic uncertainty in primary care which include a first catalogue of expressions of diagnostic uncertainty published in the Journal of General Internal Medicine in October 2022.

Mary has presented her innovative vision in a keynote address entitled Tales of Give and Take: Communication and the Diagnostic Odyssey which has been called "the highlight" of the 2nd Australasian Diagnostic Error in Medicine Conference, Melbourne (2019).

Mary's ongoing program of work on diagnostic communication also involves linguistic analysis of diagnostic statements and expression of diagnostic uncertainty in clinician-patient interactions. Together with pioneer patient advocate Maureen Williams and Dr Crock, Dr Dahm co-authored a perspective piece (2021) on interpersonal communication, cognitive bias and diagnostic errors.

In 2021, Mary’s ground-breaking interdisciplinary work has brought together not only the scientific disciplines of linguistics, health communication, consumer engagement and diagnostic error, but also a diverse team of collaborators including clinicians, patient advocates, students and even an artist. In a collaboration with third-year ANU student Marylouise Minehan, Mary’s work on communicating uncertainty in diagnostic interaction has been turned into a video game-inspired artwork “Ready Player One” displayed on a large Mural at ANU’s Exhibition Avenue.

Video production: Evana Ho/ANU

Systematic Review team

Dr Maria Dahm (Research Fellow at the Institute for Communication in Health Care)
William Cattanach (ANU Medical student)
Maureen Williams (Patient advocate)
Dr Jocelyne Basseal (Microbiologist, Infection Prevention & Control researcher and consultant)
Dr Kelly Gleason (Assistant Professor Johns Hopkins School of Nursing, USA)
Dr Carmel Crock (Director Emergency Department, Royal Victorian Eye and Ear Hospital, Melbourne)

Publications

Dahm, M. R., Cattanach, W., Williams, M., Basseal, J. M., Gleason, K., & Crock, C. (2022). Communication of Diagnostic Uncertainty in Primary Care and Its Impact on Patient Experience: An Integrative Systematic Review. Journal of General Internal Medicine.
Dahm, MR & Crock, C (2022). Understanding and Communicating Uncertainty in Achieving Diagnostic Excellence. JAMA.
Dahm, MR & Crock, C (2021). Diagnostic Statements: A linguistic analysis of how clinicians communicate diagnosis. Diagnosis.
Dahm, MR, & Crock C (2021). Communication of uncertainty, diagnosis and trust. BMJ Open 2021;11. doi: 10.1136/bmjopen-2021-QHRN.9
Dahm, MR, Williams, M, & Crock, C (2021). ‘More than words’ – Interpersonal communication, cognitive bias and diagnostic errors. Patient Education and Counseling, 105(1): 252-256. https://doi.org/10.1016/j.pec.2021.05.012
Dahm, MR, Crock, C, Williams, M, Cattanch, W, Basseal, J, & Covin, Y (2020). How do doctors communicate diagnostic uncertainty in primary care and how does it impact patient experience? An integrative systematic review. PROSPERO 2020 (CRD42020197624). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020197624
Best of The Best Oral Abstract at the annual US conference for the Society to Improve Diagnostic Error in Medicine: The Diagnostic Statement: Linguistic Analysis of how Clinicians Communicate Diagnosis by Dr Mary Dahm (21/10/2020)