The Future of Diagnosis: Navigating Uncertainty

Welkom in Utrecht! And welcome we felt attending the first in-person Society to Improve Diagnosis in Medicine (SIDM) conference since Covid-19 in Utrecht, the Netherlands. We (Georgia Black, Claire Friedemann Smith, and Brian Nicholson) were there on an invitation to present a workshop entitled Using Safety Netting to Navigate Uncertainty, in line with the conference title The Future of Diagnosis: Navigating Uncertainty. Day 1 started with a welcome from Dr Jennie Ward-Robinson and some thought-provoking plenaries from Prof Glyn Elwyn, Dr Sjoerd Repping, and Prof Hester den Ruijter and Carmen Erkelens on shared decision-making in clinical settings, diagnostic excellence and risk management, and diagnosing cardiovascular disease in women, respectively.

Safety netting is a diagnostic strategy used when necessary in clinical care to ensure that patients are monitored throughout the diagnostic process until their symptoms or signs are explained. It can be communicated, delivered by safety netting tools, or incorporated as a function of the broader health system. After lunch it was our turn and the seminar room filled up. Claire kicked off the session by giving an overview of what safety netting is in clinical practice, presenting some of the research she has led on effective communication of safety-netting advice and clinicians’ preferences when using electronic safety-netting tools. We invited a discussion about examples of how safety netting could be done badly. We got a lot of brilliant examples, e.g. asking patients to follow-up their symptoms with their GP where there was no ability for patients to provide this information back to their doctor, at least not within the suggested timeframe, leading to handwritten notes being left at the surgery as a ‘work around’. 

Brian then outlined the current and developing e-safety netting tools that try to remove sole responsibility from individual clinicians and patients, sharing responsibility for patient safety more widely. This included examples such as using the electronic health record to facilitate safety netting through basic coding or text-messaging reminders. He also demonstrated more sophisticated electronic health record plug-ins that facilitate whole practice visibility of safety netted patients, reminders, and communication. For our second activity we asked our attendees to design a safety netting tool where there were no constraints on budget or technology – think big!

Finally, Georgia demonstrated that there are many points along the patient’s diagnostic journey where things can go wrong and safety netting could be needed. She also suggested that effective safety netting needs a whole systems approach and talked through work she had led to establish a set of criteria against which effective e-safety netting tools can be evaluated. The final activity involved groups explaining their ideas for an ‘anything is possible’ e-safety-netting tool to another group and working on ways to improve it. Each group presented their inventions, and the discussions they had had around potential design flaws and fixes.

The workshop was great fun for us and we hope it was as enjoyable for those who attended. So many creative ideas were shared (Drones!). It was fantastic to discuss what we have learnt about safety netting with an international group of engaged colleagues who all brought first-hand experience of the need for robust safety netting systems from as patients, researchers, and clinicians. Thanks so much to the SIDM organisers for their invite to deliver the workshop and to the attendees for their enthusiasm.