DX error by age groups

Kathryn Montgomery kmontgomery at NORTHWESTERN.EDU
Wed May 1 01:07:42 UTC 2013


Aristotle talks about it too-- in the Nicomachean Ethics.  He says that phronesis--which maps fairly well onto system 1 thinking--is emphatically NOT the property of the young.   Hence the hothouse of residency training?

Kathryn



Kathryn Montgomery, PhD
Julia and David Uihlein Professor of Medical Humanities and Bioethics
Professor of Medicine
Director of Graduate Studies in Medical Humanities and Bioethics
750 North Lake Shore Drive - Suite 625
Chicago, Illinois 60611, USA   bioethics.northwestern.edu<http://bioethics.northwestern.edu>

On Apr 30, 2013, at 2:00 PM, Geoff Norman wrote:

The issue of aging is central to a dual processing model (Eva talks about this). It's one thing to show formal knowledge, adherence to guidelines, etc. falls off with age (The Ramsey, Leigh, Norcini and Day studies as well as Choudhry). But it's another to show that diagnostic errors go up with age, as with increasing age/experience docs rely more on system 1, which is mainly based on direct experience, and presumably goes up with age. It could be then, that the almost flat line between age and accuracy (if it is a flat line) is a sum of a decaying formal knowledge and an increasing experiential knowledge. Also a good reason to look for curvilinearity.

BTW, the Choudhry article contains a major error wrt . the Norcini study of mortality rates in CCU. See my letter to editor.


Geoff

Geoff Norman
norman at mcmaster.ca<mailto:norman at mcmaster.ca>

MDCL 3519
McMaster University
1200 Main St. W.
Hamilton ON L8N3Z5, Canada

norman at mcmaster.ca
(905) 525-9140, ext.22119



On 2013-04-30, at 1:49 PM, Randolph Miller wrote:

Here are a few old references

Ramsey PG, Carline JD, Inui TS, Larson, LoGerfo JP, Norcini JJ, Wenrich MD. Changes over time in the knowledge base of practicing internists.  JAMA. 1991;266(8):1103-7.


Leigh TM, Young PR, Haley JV. Performances of family practice diplomates on successive mandatory recertification examinations.  Acad Med. 1993;68(12):912-8.

-- Randy Miller

On Apr 30, 2013, at 4:46 AM, Jason Maude <Jason.Maude at ISABELHEALTHCARE.COM> wrote:

Hi to the new group.

Does anybody know of any studies that show dx error by age group?

Many thanks


Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com



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