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

Stefanie Lee stefanieylee at GMAIL.COM
Thu May 2 19:55:18 UTC 2013


Re: talking to each other - Absolutely, two-way communication is very
important to ensure that the interpretation fits with the clinical
scenario, and that all relevant findings and history are taken into
account. In this respect, technology has also become somewhat of a
detracting factor, in that the availability of PACS has decreased the
frequency of in-person consultations, as images and reports are only a
click away.

However, such interactions can also present a pitfall in terms of
confirmation bias - if the clinical team has a strongly favoured hypothesis
(e.g. diverticulitis rather than carcinoma in a younger patient), it can be
easy to fall into the same line of thinking and place less emphasis on
alternate interpretations for the imaging findings (after all, they are the
ones who have personally seen the patient).

Re: looking things up - of course, not meant as a supplement for knowledge
or experience - but it would serve as another checkpoint to guard against
satisfaction of search, errors due to interruptions or distractions, etc.
Similar idea to other interventions such as checklists, unless my
understanding is faulty.

Presumably the GP in Jason Maude's experience also knew that dislocations
were commonly associated with fractures, but was not internally prompted to
examine the hands side-by-side for such.


On 2 May 2013 15:11, Ross Koppel <rkoppel at sas.upenn.edu> wrote:

>  I should hope that a radiologist would not need to look up a list of
> common things associated with a fracture.....be it in a book, a computer,
> or a voice-activated computer.
>
> Ross Koppel, Ph.D. FACMI
> Sociology Dept and Sch. of Medicine
> University of Pennsylvania, Phila, PA 19104-6299215 576 8221 C: 215 518 0134
>
> On 5/2/2013 2:04 PM, Stefanie Lee 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> 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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>
>
>
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> 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.
> http://www.dem2013.org
>
>
>







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