Lack of time, knowledge or just sloppy thinking?
Wansaicheong Gervais Khin-Lin (TTSH)
gervais_wansaicheong at TTSH.COM.SG
Thu May 2 11:36:08 UTC 2013
2 cents worth:
Satisfaction of search has been described as phenomenon in radiology reporting. Once a satisfactory answer has been made, the mind 'shuts off' and stops thinking of alternatives.
Checklists, habit and teaching reinforces behavior that can avoid this trap but the results are variable. Some point out the delay in considering alternatives while others think it is a matter of just being smarter.
I think that the key is seeing how to make everybody better. The 'system' is made up of individuals who have to change in order for the system to improve. The important corollary is that not all change (in individuals) result in improvement.
Instead of deciding that only one method is needed, can we think about how a set or group of overlapping techniques can improve individuals who may have different strengths and weaknesses?
What will the community radiologist learn from this event? How will he or she change their behavior? Will they or should they?
From: Jason Maude [mailto:Jason.Maude at ISABELHEALTHCARE.COM]
Sent: Wednesday, May 01, 2013 7:22 PM
To: 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?
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