From margin to center: Transforming the landscape of diagnosis through community engagement

The diagnostic process is a complex and multifaceted journey that begins when patients first notice symptoms and seek advice from various sources, including family, friends, and digital platforms. To better understand this process, we introduce the concept landscape of diagnosis , which encompasses the diverse factors that influence diagnostic accuracy, timeliness, communication, and outcomes. Traditionally grounded in the biomedical model of health, the field of diagnostic safety is shifting toward a biopsychosocial approach that prioritizes community engagement. Yet, despite increased recognition of engaging patients, families and communities in safety practices, most interventions for reducing diagnostic error remain clinician and system focused, often failing to incorporate contributions of patients, families, and communities. We advocate for a paradigm shift in diagnostic safety practices, with impacts of social determinants of health addressed throughout the entire landscape of diagnosis. Community engagement strategies, including partnerships with local organizations and community health workers, can improve diagnostic accuracy and timeliness, particularly for underserved populations. We illustrate this with a hypothetical case showing how community health workers in partnership with community organizations can bridge gaps in follow-up care for geriatric patients with limited English language proficiency. Integrating community engagement strategies into diagnostic safety practices offers a promising path toward reducing diagnostic error and achieving more equitable health outcomes.