Triggering Questions> was: Lack of time, knowledge or just sloppy thinking?

Paul Gorman gormanp at OHSU.EDU
Thu May 2 18:54:35 UTC 2013


Actually, I think we actually used to have a system for triggering those questions and providing cognitive support.
It was called "talking to one another."

Paul

"Nothing clears up a case so much as stating it to another person."  A. Conan Doyle, Silver Blaze


On May 2, 2013, at 11:04 AM, Stefanie Lee <stefanieylee at GMAIL.COM<mailto:stefanieylee at GMAIL.COM>> wrote:

Firstly, pleasure to be part of this group and discussion.

In response to this and the other thread on satisfaction of search in radiology, I envision a solution based in the technology we use to produce reports.

With the advent of voice transcription software, a dictation of "positive for fracture" could trigger the system to prompt the radiologist about other findings commonly associated with fractures - e.g. are there any additional fractures? any evidence of dislocation? - and to address them if not already explicitly mentioned in the report.

There may be a role for structured reporting as well - for example, a trauma hand radiograph template with fields for fractures, dislocations, additional findings, etc.

As a soon-to-be radiologist, I am interested in exploring such potential solutions further. Is anyone here involved in SIIM or imaging informatics more generally?

All the best,
Stefanie

On 2 May 2013 09:25, Lorri Zipperer <Lorri at zpm1.com<mailto:Lorri at zpm1.com>> wrote:
From: Diane Zuckerman [mailto:diane at ebsolutions.com]
Sent: Thursday, May 02, 2013 6:05 AM
To: Society to Improve Diagnosis in Medicine; Peggy Zuckerman
Subject: Re: Lack of time, knowledge or just sloppy thinking?



Well stated, Peggy.




Now we need a simple solution to trigger those questions and cognitive support that is particular to the diagnosis presupposed - not just a laundry list of differential diagnosis.




Diane Z




On May 1, 2013, at 3:25 PM, Peggy Zuckerman wrote:




The reality is that our various strengths and weaknesses have led us to be the biologically advance and DIVERSE kinds of creatures that we are.  With that diversity comes the obvious physical differences, but also includes diverse ways of processing information.  One can call that "types of intelligences", with some people having greater spatial skills, others greater mathematical processing or insight, others more skilled at learning foreign languages, and so on.

The great weakness in this codified system is that the practitioners often have the same type of thinking--it does require a lot of similar skills to get through medical school vs art school--and that can become a self-limiting approach in making a diagnosis.  In the case of a difficult diagnosis, we can all certainly bring a cognitive skill to this by asking, "What am I missing here?" or "How else can I approach this problem?".  That is essentially asking for a reset to "start" at a time at which there seems a need for a decisive action.  The decisive action could also be that return to the basics, to start again, while acknowledging one's own tendencies and style of thinking.

Peggy Z






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

To learn more about SIDM visit:
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Save the date: Diagnostic Error in Medicine 2013. September 22-25, 2013 in Chicago, IL.
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