CODEX Digest 09.17.26

A complete screening test does not necessarily produce a finalized diagnostic pathway. This commentary discusses how quality metrics should move beyond screening uptake to measure timely diagnostic resolution after abnormal findings. The authors identify financial barriers and performance measures that reward testing without follow-up as contributors to “screening purgatory” and call for incentives that encompass the full screening-to-diagnosis continuum, including equity and patient outcomes.

Both systemic and clinician biases can affect diagnostic accuracy for patients from low socioeconomic backgrounds. In this commentary, the authors describe a curriculum that builds bias-mitigation skills through context-specific clinical experiences rather than generic lists of cognitive biases. Thirty third-year internal medicine students tested the combined approach, highlighting its value in identifying situational triggers and adapting reasoning strategies to reduce bias. The model offers a practical way to integrate social context into diagnostic decision-making education.

Skin cancer disparities reflect differences in prevention, detection, and access to timely treatment-- not simply individual risk. The authors of this systematic review synthesize evidence across multiple racial and ethnic populations, identifying barriers including limited access to dermatology, socioeconomic constraints, geographic inequities, and differences in screening practices and treatment. The analysis highlights the need for insurance reform, improved training in presentations in skin of color, and equitable diagnostic pathways across diverse populations.

Effective use of AI to support diagnosis requires attention to how technology interacts with people, teams, and systems, not simply model accuracy. This multidisciplinary expert workshop report highlights six knowledge-gap domains spanning AI development and validation, workflow redesign, human-team augmentation, adaptive foundation models, and governance. The resulting research agenda emphasizes risks to address that include automation bias, overreliance, and the unintended consequences of AI. The authors underscore the importance of multidisciplinary expertise as central to achieving the safe use of AI in diagnosis.

A clear understanding of program effectiveness brings value to the use of screening strategies to support diagnostic timeliness. In this Swedish population-based cohort study, investigators reassess fecal occult blood test screening outcomes after accounting for implementation biases. Screening invitation was associated with a 26% reduction in colorectal cancer mortality, while participation was associated with a 43% reduction. The findings underscore the importance of rigorous causal inference when evaluating screening programs.

Diagnostic delays in young adults may begin before the healthcare encounter. This qualitative interview study of 30 young adults with cancer finds that symptoms were frequently attributed to stress, lifestyle, or minor problems, delaying help-seeking. Online information sometimes reinforced minimization, while some participants reported feeling dismissed by clinicians. The results identify patient communication, symptom awareness, online information quality, and clinician responsiveness as modifiable diagnostic-safety targets.

AI assistance may improve immediate detection while raising questions about clinicians’ skills when the technology is removed. This Norwegian clinical trial examines the possibility of skill change after AI exposure in clinicians of different experience levels. Thirteen endoscopists completed 5,013 colonoscopies before, during, and after computer-aided detection (CADe). CADe temporarily increased detection of polyps ≥5 mm among inexperienced endoscopists, but no significant upskilling or deskilling was evident after CADe removal. The findings argue against assuming either benefit or harm without longitudinal evidence.

Digital access may increase healthcare activity without necessarily improving diagnostic outcomes. This English cross-sectional study analyses 31.2 million online triage forms from 3,053 general practices with cancer diagnostic indicators. It finds that greater online-triage use was associated with more urgent suspected-cancer referrals and investigations, but not more cancer diagnoses or fewer emergency presentations. The results illustrate that increased referral volume may represent lower-yield activity rather than improved diagnostic performance.

Early recognition of infection and sepsis is challenging because symptoms can be nonspecific and test results delayed. Taiwanese researchers developed and externally validated an AI-supported clinician decision-support tool using ICU patient data to identify possible infection and sepsis risk hours earlier than usual recognition. In thousands of real-world admissions, it prioritized sensitivity and provided bedside risk information. While the results are encouraging, clinical impact and workflow effects of the system will require further evaluation.

Patients’ and caregivers’ experiences of being dismissed can represent a diagnostic-safety problem rather than simply a communication failure. This narrative review connects medical gaslighting with established mechanisms of diagnostic error, including diagnostic overshadowing, premature closure, and failure to incorporate caregiver information. The authors propose reframing the phenomenon as a measurable vulnerability, emphasizing structured reassessment, cognitive debiasing, and greater integration of patient and caregiver concerns.

Diagnostic error is a patient-safety issue across healthcare disciplines, including dentistry. The authors examined dental malpractice claims reported to the National Practitioner Data Bank from 2004–2021, comparing diagnostic and nondiagnostic allegations and associated harm severity and payments. The study highlights the clinical and financial consequences of dental diagnostic errors and broadens diagnostic-safety surveillance beyond medicine, while recognizing that malpractice claims represent only a subset of diagnostic harm.

Patient care failures are multifactorial in nature and require systemic examination to identify contributing factors and design effective solutions. This single-institution retrospective event analysis of reported safety events finds that radiology accounted for 3.2% of events and that radiologists were involved in 9.3% of the events, mainly in diagnostic and procedural actions. Medication and contrast administration was the highest-risk category, with pediatric and older adult patients disproportionately affected, underscoring the need for standardized, system-level quality review.