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Medicine is a human endeavor aided by a sophisticated set of diagnostic tools. Healthcare systems are challenged with incorporating new and unfamiliar technology into existing systems of practice. As diagnostic tools such as artificial intelligence have entered the realm of clinical practice, new opportunities have arisen to optimize healthcare delivery. Overreliance on AI may lead to the dehumanization of medicine. However, with appropriate implementation, AI can free up time and resources to allow healthcare providers to focus on aspects of care that are unique humanistic. Effective medical practice requires availability of data, application of information, and appropriate clinical judgement. A large portion of modern patient care takes place without the presence of the patient. AI has shown the potential to synthesize and summarize vast amounts of data from medical records, clinical trials, and best-practice guidelines. By tailoring all available data to each case, AI can serve as an asset in enhancing diagnostic accuracy and increasing the efficiency of healthcare delivery. However, clinical decisions made between patients and their physicians cannot be reduced to a set of parameters, code, or logic trees. Clinical judgment and the implementation of available information remains necessarily human tasks. Only through a strong therapeutic relationship built on trust and empathy can shared decision making and compliance be attained. We propose a framework through which AI and humanistic medicine can build on one another to create a symbiosis of the highest possible caliber of patient care and healthcare quality.

Balancing efficiency with healthcare quality is an emerging concern around the world. Deep-seated feedback loops are being realized in healthcare systems around the world, driving physician burnout, unnecessary healthcare costs, and suboptimal clinical outcomes. These are not localized or insignificant issues – they are present across cultures, continents, and all medical disciplines. Physician burnout is nearly doubling the rate of medical errors, and physicians involved in major errors are experiencing a threefold increase in suicidal ideation. As the complexity of health systems increases around the world, these trends continue to evolve and perpetuate one another. We have recommended that through non-punitive and interdisciplinary approaches, medical error can be properly disclosed, addressed, and mitigated in future practice. Systemic strategies to optimize healthcare delivery include shifting focus to the quality of care rather than productivity while fostering innovation in clinical practice and policy.

The introduction of an unfamiliar disease has added uncertainty to many aspects of the practice of medicine. Evidence-based-guidelines on the recognition, investigation, and treatment of COVID-19 and its sequelae are in early stages. Clinicians are often left making critical diagnostic and treatment decisions in the absence of clear evidence. Operating in the face of uncertainty has brought to light fallibilities in clinical decision-making processes in healthcare systems around the world. A growing body of literature on COVID-19 and its associated Multisystem Inflammatory Syndrome has revealed self-perpetuating cycles of cognitive biases with far-reaching implications on patients, populations, and healthcare systems. We describe the implications of cognitive biases on decision making processes in the context of the COVID-19 pandemic. In an era when even the most experienced of clinicians find themselves navigating unchartered territory, we must rely on tried-and-true diagnostic decision-making processes to mitigate cognitive biases. To address a challenge of such complexity, we incorporate a problem spaces perspective to clinical decision making, encompasses the broader context in which decisions are made, including workplace environment, team dynamics, patient wishes, practitioner perspectives, framing of the problem, and sociocultural factors. By applying evidence from relevant disciplines, we highlight strategies to mitigate cognitive biases during emerging infectious disease pandemics, including optimizing multidisciplinary decision-making, building redundancies, and strengthening decision making processes. Continuous feedback, recalibration, and reflection will provide a better understanding of the art of diagnostic decision making and improve healthcare quality.

The capabilities of artificial intelligence (AI) in medicine are expanding at an unprecedented pace. AI has the potential to serve as an invaluable asset in harnessing large amounts of data to generate new diagnostic models, inform clinical decision making, and to expand the capabilities of modern medicine. AI has proven beneficial in various fields of diagnostic medicine including radiology, pathology, and laboratory medicine. AI programs have been shown to increase workflow without compromising accurate identification of abnormalities. Aspects of human error in medicine can be mitigated through the use of machine learning programs to serve as quality assurance and failsafe strategy. The advent of AI in healthcare carries many ethical, legal, and accountability challenges. These challenges include issues of transparency, data security, informed consent, and liability. Lack of familiarity with AI systems and fear of unforeseen consequences warrants caution in the implementation of these new tools. However, undue delays in the implementation of AI may unnecessarily hinder the progress of medicine and limit the level of care that can be provided to patients. Healthcare providers should ensure they are well-positioned to adapt to this new technological era of medicine by remaining up to date on the implications of technological advances. Medical education will require continuous revaluation and adaptation to ensure learners gain the appropriate digital literacy to function effectively in AI-assisted medical practice. The implementation of these technologies into healthcare systems represents the greatest healthcare transition of our time. Optimizing this transition in a growing number of medical disciplines will require tactful implementation and diligent risk management.

The quality of healthcare is an emerging concern worldwide. In any health care process, adverse events resulting from errors are inevitable. The role of the medical autopsy is evolving yet it remains a cornerstone in the progress of healthcare quality and diagnostic medicine. Although the autopsy has been instrumental in understanding disease processes for the past 3000 years, there has been a concerning decrease in autopsy rates. This trend is influenced by barriers pertaining to resources, consent, and medicolegal hesitations. Reversing the trend in falling autopsy rates will require recognition of the role of the medical autopsy as an essential feedback mechanism in healthcare quality improvement. The autopsy has shaped the current state of medicine and with appropriate implementation, support, and collaboration will continue to guide the path forward.

Medical error has become a major issue around the globe. When errors occur, healthcare practitioners are faced with the ethical dilemma of if, and to whom to disclose the errors. This dilemma of disclosure is faced by healthcare providers across all disciplines, countries, and generations and has far-reaching implications on the progress of healthcare quality. Medical error disclosure is a necessary step to foster a culture of transparency, strengthen partnerships, and improve the quality of healthcare. Although the principle of medical error disclosure is widely acknowledged and endorsed by providers and patients, disclosure is far from common practice. We reviewed Canadian and global disclosure policies and discuss what steps should be taken to remedy the status quo. We suggest the implementation of a uniform policy centered on addressing errors in an ethical and non-punitive manner while respecting the patient’s right to an honest disclosure be a standard of care.

Disclosure of an adverse event is an important element in managing the consequences of a medical error. The objectives of this study was to review and compare the disclosure policies implemented by individual health care authorities and hospitals in western Canada. The evaluation of the policies of individual health authorities was carried out based on the inclusion of various guidelines including avoidance of blame; support to the staff; an apology or expression of regret; avoidance of speculation; some form of patient support; and education/training to health care workers. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners are balancing the ethical complexities involved in error disclosure with other related fields. We suggest that the disclosure policies can provide framework and guidelines for appropriate disclosure that can lead to practices that are more transparent.

Autopsy diagnoses have traditionally been used as the “Gold Standard” for determining the cause of death. The purpose of this study was to use autopsy to determine the rate of concordance and discordance between clinical diagnoses and post-mortem findings in patients admitted to the hospitals of the Saskatoon Health Region. A retrospective record review of the medical and autopsy charts was carried out by three independent observers for all the deceased adult in-patients admitted during 2006 to 2008. In accordance with selection criteria, 102 (59 males; 43 females) cases were assessed. The concordance rate between clinical and autopsy diagnosis was found to be 86.3%. The discordance rate was 12.7% and in 1.0% was inconclusive. We encourage residents and physicians to continue using autopsy as an important tool to extend our understanding of disease processes.

In the present study, we investigated if there are any diurnal variations in serum thyroid stimulating hormone (TSH) levels in normal subjects and any alterations in serum TSH, free thyroxine (fT4), and free triiodothyronine (fT3) levels with aging. Our results showed the presence of a circadian rhythm in serum TSH levels in normal subjects (n = 11; 5 males, 6 females; age range 19–46) with no significant changes in fT3 and fT4, indicating that the regulation of TSH is central rather than peripheral. In addition, we examined samples from 1,571 euthyroid outpatients (513 males, 1,058 females; age range 10–90) over a 6-month period. Serum TSH levels in age groups 50–59, 60–69, 70–79, and 80–89 were found to be progressively higher than those in the age group 10–19 with no significant differences between male and female populations. These findings suggest the presence of an alteration in TSH secretion with aging.

Various strategies have been adopted to reduce medical diagnostic laboratory errors. Proficiency testing (PT) is one of the most efficient external quality assessment (EQA) approaches which include an external assessment of a laboratory’s analytical performance in comparison to its peers or to an accuracy-based reference system. To assess quality, the clinical biochemistry laboratory routinely participated in two external PT programs: Provincial Health Metrx and College of American Pathologists (CAP) survey. In Health Metrx, 598 tests for 43 analyte resulted in 3 discrepancies, yielding a total discrepancy rate of 0.50%. In CAP survey, of 431 tests for 58 analyte, 3 discrepancies resulted, yielding a total discrepancy rate of 0.70%. These results are in sync with the performance criteria and requirements set up by provincial regulatory agencies and both PT surveys. We suggest that proficiency testing programs should be an integral part of quality care to promote continuous quality improvement in healthcare.

Polymorphonuclear (PMN) leukocytes are one of the most important defenses against bacterial infections. The reports of age related functional changes in PMN leukocyte have been conflicting in the literature. We measured the luminol-dependent chemiluminescence (LDCL) activity for reactive oxygen species (ROSs) and superoxide anion (O2-) production in vitro, to study the age related functional changes in PMN leukocyte. Luminol-dependent chemiluminescence activity for ROSs and superoxide anion generation by PMN leukocyte from different age groups did not change significantly. There were no significant differences in total white blood cells and PMN counts in subjects of various ages. These results suggest that there were no significant functional alterations in PMN leukocyte with aging with respect to ROSs and superoxide anion production.

In any health care process, adverse events resulting from errors are inevitable. Failure to inform the patient of adverse events caused by a medical error compromises the autonomy of the patient. Disclosure of an adverse event is an important element in managing the consequences of a medical error. Physicians should seek to disclose medical errors to patients and their families on both ethical and pragmatic grounds. Effective communication between health care providers, patients and their families throughout the disclosure process is integral in sustaining and developing the physician patient relationship.