Past research already reveals multiple ways elicitation can be improved beyond existing methods. But that is just the start of an extended process of methodological refinements. Once narrative accounts can be more reliably elicited, they may lead to an entirely new family of performance metrics that characterize the prevalence of harms associated with diagnostic mishaps. These metrics may also address the capacity of the healthcare system to assist patients and families who have experienced those harms.
Making this potential a reality calls for an investment of additional resources, applied in multiple stages. As noted above, substantial work is still needed to adapt elicitation methods to the challenges of the diagnostic process, particularly in situations that pose the greatest challenges for patients and families to reliably assess what has occurred. Once these methodological improvements have been made, additional research will be needed to most effectively code narrative content so that actionable feedback can be identified and quantifiable metrics calculated.
Perhaps the most crucial investments will come from healthcare systems and practices, as they experiment with the use of narrative feedback for improving the diagnostic experiences of their patients. Past research suggests that many clinicians will welcome the availability of narrative insights,37 but not all will be accepting. Even those predisposed to learn from patient narratives may find it daunting in practice, when time to review this material is scarce and the autonomy to respond in constructive ways often constrained.
Learning how to most constructively provide narrative feedback is essential. That will depend on our collective capacity to learn from initial experimentation and adapt feedback methods accordingly.
