FW: DX error by age groups

Lorri Zipperer Lorri at ZPM1.COM
Wed May 1 15:58:25 UTC 2013

From: Meier, Frederick [mailto:FMEIER1 at hfhs.org] 
Sent: Wednesday, May 01, 2013 9:46 AM
To: 'Society to Improve Diagnosis in Medicine'; 'Kathryn Montgomery'
Subject: RE: DX error by age groups


KM--That's a keen observation; Aristotelean [rather than modern]
understanding of ' habit' [the improving effect of right practice] fits in
here, too--FAM


From: Kathryn Montgomery [mailto:kmontgomery at NORTHWESTERN.EDU] 
Sent: Tuesday, April 30, 2013 9:08 PM
Subject: Re: DX error by age groups


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 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


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 Norman
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.



Leigh TM, Young PR, Haley JV. Performances of family practice diplomates on
successive mandatory recertification examinations.  Acad Med.


-- Randy Miller


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


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




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