DX error by age groups

John Brush jebrush at ME.COM
Wed May 1 17:18:09 UTC 2013


David Hume talks about habit and custom as well to justify our use of inductive reasoning.
J

Sent from my iPad

On May 1, 2013, at 11:58 AM, Lorri Zipperer <Lorri at ZPM1.COM> wrote:

> 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
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> 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
>  
>  
>  
> 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  
> 
> 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. 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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