Lack of time, knowledge or just sloppy thinking?

Michael.H.Kanter at KP.ORG Michael.H.Kanter at KP.ORG
Wed May 1 20:33:58 UTC 2013


In my view it is not the checklists per se but also the culture that
accompanies the checklist that creates safety and reliability.  Checklists
alone do not add all that much value



Sent with Good (www.good.com)



-------- Original Message --------

From :      Alan Morris <Alan.Morris at IMAIL.ORG>
To :		 IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Cc :
Sent on : 05/01 07:07:38 AM PDT
Subject : Re: Lack of time, knowledge or just sloppy thinking?

If we did this to pilots, no one would fly.
Paradoxically, we have tools to address this – but virtually no support of
interest from funding agencies to pursue development.
Have  a nice day.

Alan H. Morris, M.D.


From:  "Dr.Will" <dr.will at fuse.net>
Date:  Wednesday, May 1, 2013 7:54 AM
To:  'Society to Improve Diagnosis in Medicine' <
IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Alan H. Morris, MD" <
alan.morris at imail.org>
Subject:  RE: Lack of time, knowledge or just sloppy thinking?

Yes and EMR data entry requirements have exceeded human capability to
provide good clinical care (and both eyes and physical contact on patient)
in the compressed time allotment by insurance payment and hospital owned
productivity requirements. No wonder there are errors in DX and Outcomes.

If we did this to pilots, there would be more errors, as well. My brother
is a retired pilot.

Will Sawyer, MD





From: Alan Morris [mailto:Alan.Morris at IMAIL.ORG]
Sent: Wednesday, May 01, 2013 9:26 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: Lack of time, knowledge or just sloppy thinking?



My assessment is that human think is "sloppy",  by which I mean more
attuned to system 1 than system 2 cogitation (re Khanneman, Thinking Fast
and Slow).  This is why, I believe, pilots and the FAA have for so long
relied on checklists.  It reflects their implicit appreciation of human
thought limitations.

Have  a nice day.



Alan H. Morris, M.D.

Professor of Medicine

Adjunct Prof. of Medical Informatics

University of Utah



Director of Research

Director Urban Central Region Blood Gas and Pulmonary Laboratories

Pulmonary/Critical Care Division

SorensonHeart & LungCenter - 6th Floor

IntermountainMedicalCenter

5121 South Cottonwood Street

Murray, Utah  84157-7000, USA



Office Phone: 801-507-4603

Mobile Phone: 801-718-1283

Fax: 801-507-4699

e-mail: alan.morris at imail.org

e-mail: alanhmorris at gmail.com



From: Jason Maude <Jason.Maude at ISABELHEALTHCARE.COM>
Reply-To: Society to Improve Diagnosis in Medicine <
IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Jason Maude <
Jason.Maude at ISABELHEALTHCARE.COM>
Date: Wednesday, May 1, 2013 5:22 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: Lack of time, knowledge or just sloppy thinking?



As another research focus, I think it would be useful to try and look at dx
decision errors and analyse whether they were due to lack of time, lack of
knowledge or just sloppy thinking. This again would have a big influence on
possible solutions.



I experienced my own, minor, misdiagnosis a few weeks ago which I recounted
in a blog:
http://info.isabelhealthcare.com/blog/bid/177313/Differential-diagnosis-the-crucial-trigger-for-thinking-better



In short, I damaged my hand and got an initial diagnosis (from my GP) of a
fractured 4th metacarpal which was confirmed on x-ray. A routine review of
the x-ray 2 days later (by a senior radiologist) showed that I had also
dislocated my 5th carpometacarpal joint which was much more serious and
needed an immediate operation. Hopefully there will be no long term damage.
The ortho that carried out the operation said that the dislocation "stuck
out like a sore thumb" on the x-ray!



None of the clinicians I saw was rushed so this simple mistake couldn't
have been due to lack of time and I concluded was either due to lack of
knowledge or, more likely, sloppy thinking.



Were Rob's errors below due to lack of time or sloppy thinking? If time was
not the issue then the solution has to be a practical trigger to step back
and think more methodically. At what point does lack of time move from
being a reasonable explanation to just an excuse for sloppy thinking?







Jason Maude

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



From: robert bell <rmsbell at ESEDONA.NET>
Reply-To: Society to Improve Diagnosis in Medicine <
IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, robert bell <rmsbell at ESEDONA.NET>
Date: Tuesday, 30 April 2013 19:07
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: DX error by age groups



I wonder if there are any fairly accurate surrogates for medical errors
including diagnostic.



We all forget something everyday.



For two days I collected all the ones that annoyed me, were somewhat
inconvenient.



e.g.

Getting into the car in the garage and forgetting the letter to be mailed.

Driving off and forgetting to check that the garage door is down.



If I remember correctly I had 7 one day and 5 the next!!



Try it.



Beat me and then I will then divulge my age?!



Rob Bell







On Apr 30, 2013, at 10:48 AM, Lorri Zipperer wrote:





From: Geoff Norman [mailto:norman at mcmaster.ca]
Sent: Tuesday, April 30, 2013 11:45 AM
To: Society to Improve Diagnosis in Medicine; Henriksen, Kerm (AHRQ)
Subject: Re: DX error by age groups



To continue answering the question that wasn't asked, Kevin Eva wrote a
review article for Academic Medicine on the aging physician:



Acad Med. 2002 Oct;77(10 Suppl):S1-6.

The aging physician: changes in cognitive processing and their impact on
medical practice.

Eva KW.



As to teaching / non-teaching latest Acad Med has an article on AMI
survival rates, controlling for patient factors, and looking at community /
minor teaching / major teaching. No significant differences.





Geoff



Geoff Norman

norman at mcmaster.ca



MDCL 3519

McMasterUniversity

1200 Main St. W.

Hamilton ON L8N3Z5, Canada



norman at mcmaster.ca

(905) 525-9140, ext.22119







On 2013-04-30, at 11:07 AM, Henriksen, Kerm (AHRQ) wrote:






Residency training is mentioned, so isn’t Geoff referring to
practitioners?





Kerm Henriksen, PhD

Human Factors Advisor for Patient Safety

Agency for Healthcare Research and Quality

540 Gaither Road

Rockville, MD20850



e-mail:  Kerm.Henriksen at ahrq.hhs.gov

phone: (301) 427-1331

fax:        (301) 427-1341



From: Eta S Berner [mailto:eberner at UAB.EDU]
Sent: Tuesday, April 30, 2013 10:50 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: DX error by age groups



I thought you meant by age of the patient, like are there likely to be more
errors in kids, in the elderly etc.



*********************************************

Eta S. Berner, Ed.D.

Professor, Health Informatics

Director, Center for Health Informatics for Patient Safety/Quality

Department of Health Services Administration

School of Health Professions

Professor, Department of Medical Education

School of Medicine

University of Alabamaat Birmingham

1675 University Blvd. #534

Birmingham, AL35294

Phone: (205)975—8219

Fax:       (205)975-6608

Email:   eberner at uab.edu



From: Geoff Norman [mailto:norman at MCMASTER.CA]
Sent: Tuesday, April 30, 2013 9:35 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: DX error by age groups



I have been tracking exactly this question for some time.. I have located
probably 15 studies that address the question. First of all, it's easy to
show a strong positive relationship with residency training, which is not
the case if you look at measures like adherence to guidelines, ABIM
performance etc. But beyond residency it's more tricky.I have not
summarized the data quantitatively as yet, but I think the best guess is
that there is a small negative relation between age and dx error, typically
around -0.1.  And many outliers. In one study we did with elite internists,
the best performer was 65, and the worst performer was 65.



But a tantalizing possibility is that it may follow the "10,000" hour curve
and be curvilinear, peaking at around 45. There's just not enough data to
find this.





Geoff



Geoff Norman

norman at mcmaster.ca



MDCL 3519

McMasterUniversity

1200 Main St. W.

Hamilton ON L8N3Z5, Canada



norman at mcmaster.ca

(905) 525-9140, ext.22119



 On 2013-04-30, at 5:46 AM, Jason Maude 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














Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX


Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


Save the date: Diagnostic Error in Medicine 2013. September 22-25, 2013 in
Chicago, IL.
http://www.dem2013.org



Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX


Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


Save the date: Diagnostic Error in Medicine 2013. September 22-25, 2013 in
Chicago, IL.
http://www.dem2013.org

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

HTML Version:
URL: <../attachments/20130501/178cd2aa/attachment.html>


More information about the Test mailing list