CODEX Digest 08.20.26

Clinical workflow adjustments to incorporate AI may influence liability. Using experimental scenarios, this preprint examines how different AI-human workflow designs affect radiologists' diagnostic decisions and perceptions of legal responsibility by hypothetical jurors. The findings suggest that AI-centric workflow changes involving double-reads, documentation of decision changes, and AI error rate transparency may shape clinician behavior, highlighting the need for careful evaluation before implementation.

Digital communication can accelerate triaging of patient concerns. This quality improvement initiative tested the use of written materials and patient education to increase secure submission of patient-uploaded postoperative photographs following surgery, enabling earlier diagnosis of potential surgical site infection. The program demonstrates how simple workflow improvements may strengthen diagnostic communication, reduce delays, and improve patient safety.

Patient and family expectations for a diagnosis are important to consider during emergency department visits. This Australian interview study finds valuable nuances among patient expectations, shaped by prior healthcare experiences, understanding of symptoms, medical familiarity, and uncertainty tolerance.

Future advances in diagnostic safety require impactful and stakeholder-centered research priorities. Researchers and patients collaborated to identify the most important unanswered questions in clinical reasoning research. The analysis emphasizes the identifies thematic interests of the work: cognitive processes, systems factors, patient engagement, and educational strategies. The resulting agenda provides a roadmap for future multidisciplinary research on clinical reasoning.

Diagnostic reasoning skills acquisition is central to advanced nursing practice. This Canadian interview study explores how registered nurses develop diagnostic reasoning as they transition to nurse practitioner roles. The results identify four areas of emphasis: structured sense-making tied to professional identity shifts; prior RN experience as both help and hindrance; diagnostic reasoning developing amid complexity and constraint; and scaffolded, iterative paths to diagnostic skill. The findings identify educational and experiential factors that support increasingly sophisticated clinical reasoning, with implications for workforce development and diagnostic safety.

Everyday discrimination may influence when and how people seek care. In a national cross-sectional study of U.S. adults, experiences of discrimination were associated with differences in healthcare utilization including screening activities. The findings highlight an important pathway through which experiences of oppression may contribute to delayed diagnosis and disparities in diagnostic outcomes.

Improving diagnosis requires a coordinated research effort to support excellence. This NIH topic synthesis highlights diagnostic safety and quality as an area of research emphasis. The announcement encourages multidisciplinary studies spanning clinical reasoning, health systems, technology, patient engagement, implementation science, and health equity to improve diagnostic performance across healthcare.

Screening benefits should be assessed long-term. This cohort study evaluates both long-term mortality and overdiagnosis within the UK's NHS breast screening program for over three decades. Patients invited to breast cancer screening had a 28% lower risk of dying from the disease, and those who actually attended had a 33% lower risk, though screening was also linked to a 4% overdiagnosis rate over at least five years of follow-up. The results may bolster policies supporting population health-based breast cancer screening.

Imaging decisions are best when they consider patient priorities as well as clinical evidence. This perspective argues that radiology leaders can advance diagnostic excellence by embedding shared decision-making throughout imaging pathways. The authors describe organizational strategies that encourage patient engagement, improve communication about diagnostic testing, use patient-reported measures, and support more person-centered imaging decisions. They highlight training, protected time, and strategic AI implementation among mechanisms enabling improvement.

Atrial fibrillation (AF) misdiagnosis in the emergency department (ED) may lead to patient harm and unneeded pharmacotherapy. This retrospective, single-center Israeli study examines how emergency physicians interpret ECGs to identify AF without computerized assistance. This review of discharge records reveals a misdiagnosis rate of 2.7%.

Improving the expediency of lung cancer diagnosis requires assessment of a variety of factors. This regional Australian study explored why lung cancer diagnoses are delayed, combining medical record reviews with interviews from 29 patients and general practitioner record analysis. The results find that the diagnostic wait averaged 19 days but varied widely. Patient-clinician and system issues—like communication gaps, access constraints, and limited health literacy—had the biggest impact, suggesting these areas be targeted for improvement of diagnostic timeliness.

Patients are increasingly turning to AI before clinicians. This commentary examines why patients may seek initial diagnostic information from chatbots, including convenience, accessibility, and perceived anonymity. The author submits that healthcare organizations work to understand these evolving behaviors, prepare effective cautionary communications and develop approaches that help patients integrate AI-generated information safely into clinical care.