Diagnostic Error in Health Care

Consensus

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Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative.

Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errors—has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

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Publication information

472 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-37769-2
ISBN Ebook: 0-309-37770-6
DOI: https://doi.org/10.17226/21794

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press.

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John R. Ball

John R. Ball, M.D., J.D. (Chair), is an Executive Vice President Emeritus of the American College of Physicians. He is a graduate of Emory University, received a JD and an MD from Duke University, and was a Robert Wood Johnson Clinical Scholar at George Washington University. After a residency in internal medicine at Duke University, he held several health policy positions in the US Public Health Service and was a Senior Policy Analyst in the Office of Science and Technology Policy, Executive Office of the President. Dr. Ball originated the Washington Office of the American College of Physicians and served as its executive vice president for eight years. He subsequently was president and chief executive officer of Pennsylvania Hospital and executive vice president and chief executive officer of the American Society for Clinical Pathology. In retirement, he has recently served as interim president of the Milbank Memorial Fund, on whose board he also serves. He is also a member of the board of Mission Health System in Asheville, North Carolina, where he resides. Dr. Ball was elected a member of the Institute of Medicine in 1992.

Elisabeth Belmont

Elisabeth Belmont, Esq., serves as Corporate Counsel for MaineHealth which is ranked among the nation's top 100 integrated healthcare delivery networks. She has significant experience in the defense of professional liability claims and assists healthcare providers in using “lessons learned” from such claims to inform quality improvement and patient safety initiatives to minimize medical errors. Ms. Belmont’s practice also focuses on electronic health information network strategy development and implementation to support innovations in care delivery and payment models as well as the use of “Big Data” to enhance care processes and clinical outcomes. She has participated in a number of national initiatives where quality improvement, patient safety and health information technology intersect including events sponsored by the DHHS Office of the National Coordinator and the DHHS Office of the Inspector General. Ms. Belmont is a Past President of the American Health Lawyers Association, former Chair of the Association’s Health Information & Technology Practice Group, and currently serves as Chair of the Association’s Quality in Action Task Force. She recently served as Principal Investigator for a research study funded by the American Society of Healthcare Risk Management, Minimizing EHR-related Serious Safety Events and Related Medical Malpractice Liability.

Robert A. Berenson

Robert A. Berenson, M.D., is an Institute Fellow at the Urban Institute in Washington, D.C. He has published widely on a range of topics, including physician payment, health care cost containment, performance measurement, and malpractice reform. He was a senior official in two Administrations and recently completed a term as a Commissioner at MedPAC, the last two years as Vice-Chair. A graduate of the Mount Sinai School of Medicine, Dr. Berenson is a board-certified internist who practiced for over 20 years, including twelve years in a Washington, D.C. group practice and is Fellow of the American College of Physicians.

Pascale Carayon

Pascale Carayon, Ph.D., is Procter & Gamble Bascom Professor in Total Quality in the Department of Industrial and Systems Engineering and the Director of the Center for Quality and Productivity Improvement (CQPI) at the University of Wisconsin-Madison. She leads the Systems Engineering Initiative for Patient Safety (SEIPS) at the University of Wisconsin-Madison (http://cqpi.engr.wisc.edu/seips_home). SEIPS is an internationally known interdisciplinary research program that brings together researchers from human factors and ergonomics with researchers from medicine, surgery, nursing, pharmacy and health services research. Professor Carayon received her Engineer diploma from the Ecole Centrale de Paris, France, in 1984 and her Ph.D. in Industrial Engineering from the University of Wisconsin-Madison in 1988. Professor Carayon’s research belongs to the discipline of human factors engineering, in particular macroergonomics. Her scholarly contributions aimed at modeling, assessing and improving work systems (i.e. the system of tasks performed by individuals using various technologies in a physical and organizational environment) in order to improve system performance and worker well-being. Her research has been funded by the Agency for Healthcare Research and Quality, the National Science Foundation, the National Institutes for Health, the National Institute for Occupational Safety and Health, the Department of Defense, various foundations and private industry. She is a Fellow of the Human Factors and Ergonomics Society and a Fellow of the International Ergonomics Association. She is the Recipient of the International Ergonomics Association Triennial Distinguished Service Award (2012), and is the first woman to receive this prestigious award. She has published more than 100 papers and over 220 conference papers and 30 technical reports, and is currently the Co-Editor-in-Chief of Applied Ergonomics. She is the editor of the Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. She is a member of the National Research Council Board on Human-Systems Integration.

Christine K. Cassel

Christine K. Cassel, M.D., is President and CEO of the National Quality Forum. Previously she served as President and CEO of the American Board of Internal Medicine. Dr. Cassel is a member of the President’s Council of Advisors on Science and Technology (PCAST). She is the co-chair and physician leader of PCAST working groups that have made recommendations to the President on issues relating to health information technology, scientific innovation in drug development and systems engineering in health care delivery. She was a member of the Commonwealth Fund’s Commission on a High Performance Health System and has served on IOM committees that wrote the influential reports To Err is Human and Crossing the Quality Chasm. She is an Adjunct Professor of Medicine and Senior Fellow in the Department of Medical Ethics and Health Policy at the University of Pennsylvania School Of Medicine, former Dean of Medicine at Oregon Health and Science University, Chair of Geriatrics at Mount Sinai School of Medicine in New York, and Chief of General Internal Medicine at the University of Chicago. Dr. Cassel is a prolific scholar, having authored and edited 14 books and over 200 published articles.

Carolyn M. Clancy

Carolyn M. Clancy, M.D., was appointed Assistant Deputy Under Secretary for Health (ADUSH) for Quality, Safety and Value (QSV) for the Department of Veterans Affairs, August 25, 2013. Prior to her appointment as ADUSH for QSV, Carolyn M. Clancy, M.D., served as Director of the Agency for Healthcare Research and Quality (AHRQ), from February, 2003 through August, 24, 2013. Dr. Clancy, a general internist and health services researcher, is a graduate of Boston College and the University of Massachusetts Medical School. Following clinical training in internal medicine, Dr. Clancy was a Henry J. Kaiser Family Foundation Fellow at the University of Pennsylvania. Before joining AHRQ in 1990, she was also an assistant professor in the Department of Internal Medicine at the Medical College of Virginia. Dr. Clancy holds an academic appointment at George Washington University School of Medicine (Clinical Associate Professor, Department of Medicine) and serves as Senior Associate Editor, Health Services Research. She serves on multiple editorial boards including JAMA, Annals of Family Medicine, American Journal of Medical Quality, and Medical Care Research and Review. She is a member of the Institute of Medicine and was elected a Master of the American College of Physicians in 2004. In 2009, was awarded the 2009 William B. Graham Prize for Health Services Research. Her major research interests include improving health care quality and patient safety, and reducing disparities in care associated with patients’ race, ethnicity, gender, income, and education. As Director, she launched the first annual report to the Congress on health care disparities and health care quality.

Michael B. Cohen

Michael Cohen, M.D., is a medical director in the Anatomic Pathology and Oncology Division at ARUP, and a professor and vice chair for faculty and house staff development at the University of Utah School of Medicine, as well as Ombudsperson for the Health Sciences Center. Dr. Cohen received his MD from Albany Medical College in Albany, NY and completed his anatomic pathology residency at the University of California, San Francisco. Dr. Cohen has been on the faculty at Columbia, UCSF, and the University of Iowa; he was chair of the Department of Pathology at Iowa for more than a dozen years. In addition, he has served on numerous editorial boards, and currently serves on the American Journal of Clinical Pathology, Archives of Pathology and Laboratory Medicine, and Clinical Cancer Research. He has been a NIH-funded investigator and published extensively in the field of prostate cancer and pathology. He is the recipient of multiple honors, including the Regents Award for Faculty Excellence at the University of Iowa and the Leonard Tow Humanism in Medicine Award. Dr. Cohen has been included in Castle Connolly American's Top Doctors since 2007 and America's Top Doctors for Cancer since 2005; Consumers' Research Council of America Guide to America's Top Pathologists since 2007; and Best Doctors in America list since 2005.

Patrick Croskerry

Patrick Croskerry M.D., PhD, FRCP(Edin), is Professor in Emergency Medicine and in the Division of Medical Education at Dalhousie University, Halifax, Nova Scotia, Canada. He was appointed Director of the new Critical Thinking Program at Dalhousie Medical School in 2012. In addition to his medical training, he holds a doctorate in Experimental Psychology and Fellowship in Clinical Psychology. His research is principally concerned with clinical decision-making, specifically on diagnostic error. He was on the organizing committee of the first national conference on Diagnostic Error in 2008 and the second in 2009; he has contributed at each international conference since. He has published over 80 journal articles and 30 book chapters in the area of patient safety, clinical decision making, and medical education reform. He was senior editor on a major text Patient Safety in Emergency Medicine (2009).

Thomas H. Gallagher

Thomas H. Gallagher, M.D., is a general internist who is a Professor in the Department of Medicine and the Department of Bioethics and Humanities at the University of Washington. Dr. Gallagher received his medical degree from Harvard University, Cambridge, Massachusetts, completed his residency in Internal Medicine at Barnes Hospital, Washington University, St. Louis, and completed a fellowship in the Robert Wood Johnson Clinical Scholars Program, UCSF.
Dr. Gallagher’s research addresses the interfaces between healthcare quality, communication, and transparency. Dr. Gallagher has published over 85 articles and book chapters on patient safety and error disclosure, which have appeared in leading journals including JAMA, New England Journal of Medicine, Health Affairs, Surgery, Journal of Clinical Oncology, Archives of Internal Medicine, Archives of Pediatric and Adolescent Medicine, and the Joint Commission Journal. His work in error disclosure received the 2004 Best Published Research Paper of the Year award from the Society of General Internal Medicine, as well as the 2012 MITSS Hope Award. He also received a Robert Wood Johnson Foundation Investigator Award in Health Policy Research. He is the principal investigator on two grants from the Agency for Healthcare Research and Quality, including an AHRQ patient safety and medical liability demonstration project entitled “Communication to Prevent and Respond to Medical Injuries: WA State Collaborative.” He also is principal investigator on grants from the National Cancer Institute, the Robert Wood Johnson Foundation, and the Greenwall Foundation. He is senior author of the book Talking with Patients and Families About Medical Errors: A Guide for Education and Practice, published in 2011 by The Johns Hopkins University Press. At the University of Washington, he directs the UW Medicine Center for Scholarship in Patient Care Quality and Safety, and also directs the UW Program in Hospital Medicine. He is an appointed Commissioner on the National Commission on Physician Payment Reform.
Dr. Gallagher is an active member of many professional organizations, including the American College of Physicians (Fellow), the Society for General Internal Medicine, and the American Society of Bioethics and Humanities.

Christine A. Goeschel

Christine A Goeschel ScD. M.P.A., M.P.S., R.N., F.A.A.N., is a health services researcher and the Assistant Vice President for Quality at MedStar Health, a 10 hospital 4.6 billion dollar health system in the mid-atlantic, where she oversees quality for both the acute and non-acute care services. She is a Fellow of the American Academy of Nursing, a National Baldrige Examiner and Associate faculty in the Johns Hopkins Bloomberg School of Public Health, where she teaches a required course in the Master of Hospital Administration program. Formerly the Director of Strategic Research Initiatives at the Johns Hopkins Armstrong Institute, Dr. Goeschel serves on the board of the Maryland Patient Safety Center and is the author of several book chapters and over 65 peer reviewed articles on topics ranging from implementation of large scale clinical improvement projects to leadership for advancing the science of health care delivery and creating a culture of accountability in healthcare. Previous experience includes responsibility for Quality, Risk Management and Service Excellence in a Midwest teaching hospital and serving as an advisor to the World Health Organization Patient Safety Program. She served on the National Quality Forum National Steering Committee for Serious Reportable Events and Healthcare Associated Conditions and currently serves on an NQF panel exploring linkages between cost and quality. She is increasingly interested in the study of diagnostic errors, both etiology and understanding the relationship between misdiagnoses, missed diagnoses and wrong diagnoses and preventable morbidity, mortality, and costs of care.

Mark L. Graber

Mark L. Graber, M.D., FACP, is a Senior Fellow at RTI International and Professor Emeritus of Medicine at the State University of New York at Stony Brook. He retired as Chief of Medicine at the Northport VA Medical Center, in 2011. Dr. Graber has an extensive background in biomedical and health services research, with over 80 peer-reviewed publications. He is a national leader in the field of patient safety and originated Patient Safety Awareness Week in 2002, an event now recognized internationally. Dr. Graber has also been a pioneer in efforts to address diagnostic errors in medicine. In 2008 he convened and chaired the Diagnostic Error in Medicine conference series, and in 2011 he founded the Society to Improve Diagnosis in Medicine (www.improvediagnosis.org). In 2014 he became the founding editor of a new journal, DIAGNOSIS, devoted to improving the quality and safety of diagnosis, and reducing diagnostic error.

Hedvig Hricak

Hedvig Hricak M.D., Dr. Med. Sc. (PhD), Dr.h.c., is Chair of the Department of Radiology at Memorial Sloan-Kettering Cancer Center, Professor in the Gerstner Sloan-Kettering Graduate School of Biomedical Sciences, and Professor of Radiology at the Weill Medical College of Cornell University. She also holds a senior position within the Molecular Pharmacology and Chemistry Program of the Sloan-Kettering Institute. Previously, she was Chief of the Uroradiology and Abdominal Imaging sections of the Department of Radiology, University of California, San Francisco. She earned her MD degree from the University of Zagreb in Zagreb, Croatia and her Dr. Med. Sc. (PhD) from the Karolinska Institute in Stockholm, Sweden. Her research and clinical expertise is in the use of diagnostic imaging, specifically for the detection and assessment of genitourinary and gynecological cancers. She has worked continuously to develop and promote the use of evidence-based imaging algorithms to assist in cancer management, focusing on the development and validation of biomarkers from cross-sectional (ultrasound, MRI, CT) and molecular imaging (DCE-MRI, MR spectroscopy, PET/CT and PET/MRI). Over the last 20 years, while serving in administrative leadership positions, she has been actively engaged in continuous process improvement and quality assurance efforts. Dr. Hricak served on the National Institutes of Health, Board of Scientific Counselors, the NCI Board of Scientific Advisors and the Advisory Council of The National Institute of Biomedical Imaging and Bioengineering. She is a member of the Institute of Medicine (IOM) of the National Academy of Sciences (NAS). She served on the IOM committee that produced the report, “A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the NCI Cooperative Group Program.” Since 2008 she has been a member of the Nuclear Radiation Studies Board of the NAS. She chaired the NAS Committee on the State of the Science of Nuclear Medicine, which wrote the highly-cited report “Advancing Nuclear Medicine Through Innovation.” In addition, she chaired the 2009 Beebe symposium of the NAS, which focused on radiation exposures from imaging and image-guided interventions. The many leadership posts she has held in professional organizations include President, California Academy of Medicine and President, Radiological Society of North America Board of Directors. Over the course of her career, she has received numerous honors and awards, including “foreign” membership in both the Croatian Academy of Arts and Sciences and the Russian Academy of Medicine, and an honorary doctorate in medicine from Ludwig Maximilian University in Munich, Germany.

Anupam B. Jena

Anupam B. Jena, M.D., Ph.D., is an Assistant Professor of Health Care Policy and Medicine at Harvard Medical School and an attending physician in the Department of Medicine at Massachusetts General Hospital, where he practices general inpatient medicine and teaches medical residents. He is also a Faculty Research Fellow at the National Bureau of Economic Research. As an economist and a physician, Dr. Jena’s research involves several areas of health economics and policy including medical malpractice, the economics of medical innovation and cost-effectiveness, the economics of physician behavior, and the effect on physician quality of reforms to medical education. Dr. Jena graduated Phi Beta Kappa from the Massachusetts Institute of Technology with majors in biology and economics. He received his MD and PhD in Economics from the University of Chicago. He completed his residency in internal medicine at Massachusetts General Hospital. In 2007, he was awarded the Eugene Garfield Award by Research America for his work demonstrating the economic value of medical innovation in HIV/AIDS. In 2013, he received the NIH Director’s Early Independence Award to fund research on the physician determinants of health care spending, quality, and patient outcomes.

Ashish K. Jha

Ashish Jha, M.D., M.P.H., is a professor of health policy and management at the Harvard School of Public Health and a practicing general internist with a clinical focus on hospital care. Over the past 6 years, he has served as a senior advisor for quality and safety to the VA. Dr. Jha received his M.D. from Harvard Medical School in 1997 and trained in internal medicine at the University of California, San Francisco, where he also served as chief medical resident. He completed his general medicine fellowship from Brigham and Women’s Hospital and Harvard Medical School and received his M.P.H. in clinical effectiveness from the Harvard School of Public Health in 2004. He joined the faculty in July 2004. The major themes of his research include the impact of public policy on the healthcare delivery system with a focus on patient safety, clinical outcomes, and costs of care. Much of his work has focused on understanding how policy efforts such as public reporting, pay-for-performance, and promotion of the use of health information technology affect clinical quality, patient safety, and healthcare costs. Dr. Jha’s most recent work has focused on key levers for improvement including organizational leadership and how it affects the delivery of safe, effective, and efficient care.

Michael Laposata

Michael Laposata, M.D., Ph.D., is Edward and Nancy Fody Professor of Pathology and Professor of Medicine at Vanderbilt University School of Medicine. He is the executive vice chairman for the Department of Pathology, pathologist-in-chief at Vanderbilt University Hospital and director of clinical laboratories. He received his M.D. and Ph.D. from Johns Hopkins University School of Medicine and completed a postdoctoral research fellowship and residency in Laboratory Medicine (Clinical Pathology) at Washington University School of Medicine in St. Louis. He took his first faculty position at the University of Pennsylvania School of Medicine in Philadelphia in 1985, where he was an Assistant Professor and director of the hospital's coagulation laboratory. In 1989, he became Director of Clinical Laboratories at the Massachusetts General Hospital and was appointed to faculty in pathology at Harvard Medical School, where he became a tenured full Professor of Pathology.
His research program, with more than 160 peer reviewed publications, has focused on fatty acids and their metabolites. His research group is currently focused on the study of fatty acid alterations in cystic fibrosis. Dr. Laposata's clinical expertise is in the field of blood coagulation, with a special expertise in the diagnosis of hypercoagulable states.
Dr. Laposata implemented a system whereby the clinical laboratory data in coagulation and other areas of laboratory medicine are systematically interpreted with the generation of a patient specific narrative paragraph by a physician with expertise in the area. This service is essentially identical to the service provided by physicians in radiology and anatomic pathology, except that it involves clinical laboratory test results. In 2005, Dr. Laposata was recognized by the Institute of Quality in Laboratory Medicine of the Centers for Disease Control and Prevention for this innovation.
Dr. Laposata is the recipient of 14 major teaching prizes at Harvard, the Massachusetts General Hospital, and the University of Pennsylvania School of Medicine. His recognitions include the 1989 Lindback award, a teaching prize with competition across the entire University of Pennsylvania system; the 1998 A. Clifford Barger mentorship award from Harvard Medical School; election to the Harvard Academy of Scholars in 2002, and to the Vanderbilt University School of Medicine Academy for Excellence in Teaching in 2009; and the highest award - by vote of the graduating class - for teaching in years 1 and 2 at Harvard Medical School in 1999, 2000, and 2005.

Kathryn M. McDonald

Kathryn McDonald, M.M., has over 20 years of experience in health care, working in a variety of settings – industry, hospital and academia. She is the Executive Director of the Center for Health Policy and the Center for Primary Care and Outcomes Research (CHP/PCOR) at Stanford University, a Senior Scholar at the centers, and Associate Director for the Stanford-UCSF Evidence-based Practice Center (with RAND). Her research focuses on evidence-based healthcare quality measures and interventions, with an emphasis on organizational context and key healthcare stakeholders (patients/families, clinicians, systems administrators).
Her research portfolio includes initial and ongoing development of the publicly released Agency for Healthcare Research and Quality (AHRQ) Patient Safety and Quality Indicators (www.qualityindicators.ahrq.gov), reviews of patient safety practices (Making Healthcare Safer I and II), and two series of evidence reports on quality improvement strategies (Closing the Quality Gap, Quality Kaleidoscope). She continues to lead the Stanford measure development team for support of and expansions to the AHRQ Quality Indicators, including current efforts on care coordination measures, among others. She is the lead author of the Care Coordination Measures Atlas (www.ahrq.gov/qual/careatlas/). She has published over 100 peer-reviewed articles and evidence reports, presents regularly at national meetings, and collaborates with a wide network of investigators, health care practitioners, and patients and their families.
McDonald has a strong service record, currently as Chair of the Patient Engagement Committee of the Society to Improve Diagnosis in Medicine and Associate Editor of the journal Diagnosis. Previously, she was President of the Society for Medical Decision Making and member of an Institute of Medicine Committee that issued the report, Child and Adolescent Health and Health Care Quality: Measuring What Matters. She holds a master of management degree (MBA equivalent) from Northwestern University's Kellogg School of Management, with an emphasis on the healthcare industry and organizational behavior, and she holds a BS in chemical engineering from Stanford University.

Elizabeth A. McGlynn

Elizabeth A. McGlynn, Ph.D., is the Director of Kaiser Permanente’s Center for Effectiveness and Safety Research (CESR). She is responsible for the strategic direction and scientific oversight of CESR, a virtual center designed to improve the health and well-being of Kaiser’s 9 million members and the public by conducting comparative effectiveness and safety research and implementing findings in policy and practice. Dr. McGlynn is an internationally known expert on methods for evaluating the appropriateness, quality and efficiency of health care delivery. She has conducted research in the U.S. and in other countries. Dr. McGlynn has also led major initiatives to evaluate health reform options under consideration at the federal and state levels.
Dr. McGlynn is a member of the Institute of Medicine. She serves as the Secretary and Treasurer of the American Board of Internal Medicine Foundation Board of Trustees. She is on the Board of AcademyHealth, the Institute of Medicine Board of Health Care Services, and the Reagan-Udall Foundation for the FDA. She chairs the Scientific Advisory Group for the Institute for Healthcare Improvement. She co-chairs the Coordinating Committee for the National Quality Forum’s Measures Application Partnership. She serves on the editorial boards for Health Services Research and The Milbank Quarterly and is a regular reviewer for many leading journals.
Dr. McGlynn received her B.A. in international political economy from The Colorado College, her MPP from the University of Michigan’s Gerald R. Ford School of Public Policy, and her Ph.D. in public policy analysis from the Pardee RAND Graduate School.

Michelle Rogers

Michelle Rogers, Ph.D., is an assistant professor in the College of Computing and Informatics at Drexel University. She has more than 10 years of experience using human factors engineering methods and socio-technical systems theory to study the impact of health information technology (HIT) on clinical workflow and the usability of technology in order to support patient safety and reduce human error. Over her career, her projects focused on understanding the impact of HIT on clinical workflow and patient safety, as is demonstrated in her work with the Computerized Patient Record System (CPRS), the Bar-Code Medication Administration (BCMA) system and MyHealthVet (VA patient portal) in use at the Veterans Health Administration (VHA) where she was a faculty research scientist.

Urmimala Sarkar

Urmimala Sarkar M.D., M.P.H., is an Associate Professor of Medicine in Residence at UCSF in the Division of General Internal Medicine and a primary care physician at San Francisco General Hospital’s General Medicine Clinic. Dr. Sarkar’s research focuses on (1) patient safety in outpatient settings, including adverse drug events, missed and delayed diagnosis, and failures of treatment monitoring, (2) health information technology and social media to improve the safety and quality of outpatient care, and (3) implementation of evidence-based innovations in real-world, safety-net care settings. Dr. Sarkar has conducted studies which explore the impact of health communication (health literacy, English proficiency) and health information technology on patient safety. Her prior studies on internet-based patient portals demonstrate digital disparities by race/ethnicity and health literacy. Her social media studies use mixed-methods approaches to understand patient perspectives about physician quality and about cancer screening behaviors. Her ongoing work employs varied health information technologies to detect and ameliorate adverse events among outpatient chronic disease populations.

George E. Thibault

George E. Thibault, M.D., became the seventh president of the Josiah Macy Jr. Foundation in January 2008. Immediately prior to that, he served as Vice President of Clinical Affairs at Partners Healthcare System in Boston and Director of the Academy at Harvard Medical School (HMS). He was the first Daniel D. Federman Professor of Medicine and Medical Education at HMS and is now the Federman Professor, Emeritus.
Dr. Thibault previously served as Chief Medical Officer at Brigham and Women’s Hospital and as Chief of Medicine at the Harvard affiliated Brockton/West Roxbury VA Hospital. He was Associate Chief of Medicine and Director of the Internal Medical Residency Program at the Massachusetts General Hospital (MGH). At the MGH he also served as Director of the Medical ICU and the Founding Director of the Medical Practice Evaluation Unit.
For nearly four decades at HMS, Dr. Thibault played leadership roles in many aspects of undergraduate and graduate medical education. He played a central role in the New Pathway Curriculum reform and was a leader in the new Integrated Curriculum reform at HMS. He was the Founding Director of the Academy at HMS, which was created to recognize outstanding teachers and to promote innovations in medical education. Throughout his career he has been recognized for his roles in teaching and mentoring medical students, residents, fellows and junior faculty. In addition to his teaching, his research has focused on the evaluation of practices and outcomes of medical intensive care and variations in the use of cardiac technologies.
Dr. Thibault is Chairman of the Board of the MGH Institute of Health Professions, and he serves on the Board of the New York Academy of Sciences, the New York Academy of Medicine, the Institute on Medicine as a Profession, the New York Academy of Medicine and the Lebanese American University. He serves on the President’s White House Fellows Commission and for twelve years he chaired the Special Medical Advisory Group for the Department of Veteran’s Affairs. He is past President of the Harvard Medical Alumni Association and Past Chair of Alumni Relations at HMS. He is a member of the Institute of Medicine of the National Academy of Sciences.
Dr. Thibault graduated summa cum laude from Georgetown University in 1965 and magna cum laude from Harvard Medical School in 1969. He completed his internship and residency in Medicine and fellowship in Cardiology at Massachusetts General Hospital (MGH). He also trained in Cardiology at the National Heart and Lung Institute in Bethesda and at Guys Hospital in London, and served as Chief Resident in Medicine at MGH.
Dr. Thibault has been the recipient of numerous awards and honors from Georgetown (Ryan Prize in Philosophy, Alumni Prize, and Cohongaroton Speaker) and Harvard (Alpha Omega Alpha, Henry Asbury Christian Award and Society of Fellows). He has been a visiting Scholar both at the Institute of Medicine and Harvard’s Kennedy School of Government and a Visiting Professor of Medicine at numerous medical schools in the U.S. and abroad.

John B. Wong

John B. Wong, M.D., FACP, is chief of the Division of Clinical Decision Making at Tufts Medical Center and a Distinguished Professor of Medicine at the Tufts University School of Medicine. A past president of the Society for Medical Decision Making, he is the statistical editor for decision and cost-effectiveness analysis at the Annals of Internal Medicine, Director of Comparative Effectiveness Research at the Tufts Clinical Translational Science Institute and a co-author of Learning Clinical Reasoning. His areas of expertise include decision sciences, diagnostic reasoning, errors in test interpretation, Bayesian statistical methods, quality and appropriateness of care, health economics, patient centeredness, and evidence-based medicine.

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