Checking errors (was checklist vs checklist)

David Meyers dm0015 at ICLOUD.COM
Fri May 3 22:31:37 UTC 2013


As Ronald Reagan said, "Trust but verify."

Consider these rules:

Rule 1:  Medicine is too complicated for (unaided) human beings.
Rule 2: Make it easier to do the right thing than the wrong thing.
Corollary: The approach of "All you [clinician] have to do is [e.g., follow the 10 commandments previously listed, interrupt your work flow to go check some resource, stop and think whether I've remembered everything I should about this situation, etc]…" is not a good solution because it is NEVER all we have to do.
Rule 3: Different specialties - emergency medicine, radiology, IM office practice, hospitalist medicine, dermatology, etc - need different strategies and approaches to prevention of diagnostic error which are appropriate to their respective environments of practice, biases, training, etc. One size will not fit all.

David L Meyers, MD, FACEP
dm0015 at icloud.com
Mobile:	410-952-8782
Fax:		410-367-0449
The bourgeoisie has stripped of its halo every occupation hitherto honored and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science into its paid wage laborers.
Karl Marx, 1848, Communist Manifesto

On May 3, 2013, at 1:18 PM, robert bell <rmsbell at ESEDONA.NET> wrote:

> Thanks Peggy Z.
> 
> Interesting, not unlike the errors when one person checks the others work (e.g. blood checking systems) - the second person makes the same error as the first - ? about 5% of the time believing the first person is correct. ? not properly checking because of trust, or time restraints, or other issues.
> 
> How do you overcome this kind of error?
> 
> Should there be a culture of trusting no one in medicine?!
> 
> Rob Bell
> 
> On May 3, 2013, at 9:12 AM, Peggy Zuckerman wrote:
> 
>> Re Mark's study showing " value in being alerted to patients at highest risk for dx error (patients arriving
>> with a diagnosis; patients seen in the ER a few days ago, etc)".  This is a critical point, as it underscores the common theme of an earlier diagnosis confounding or blinding the next and the next provider to accept without question that the first "read" or interpretation is correct.  This is no doubt tied to the issue of seeking efficiency, and that of not wanting to be the nay sayer or oddball in the group think that can accompany this.
>> 
>> In my kidney cancer world, there are countless stories of patients being treated for a diagnosis offered by the initial doctor, used as the basis for a varying treatment by a second, all without benefit until someone takes a fresh look.  Relying on an older mistake must be very frequent and hard to discard!
>> 
>> Peggy Z
>> 
>> 
>> On Fri, May 3, 2013 at 8:02 AM, <Bettygene.Egan at kp.org> wrote:
>> 
>> I have been reading the numerous emails on this subject and find the dialog robust.  It is also clear that this is a very challenging area with many opinions.  Ross and Harold's comments relate to a project that I have been working on and some of you may recall seeing at last year's DEM Conference in Baltimore.  Dr. William Strull and I briefly talked about a tool for patients named SMART Partners.  S=symptoms, M=medication/medical history, A= assessment, R= review, T= to do.  The concept of the SMART Partners is to provide patients with a tool to help prepare them for their appointment and to be engaged in their care, a checklist of sorts for the patient. 
>> 
>> I ran a very small pilot in one of our medicine clinics and the results show that the patients like the guide, 86% (n=590) said they will use it at a future visit.  A post-survey for the physicians shows an increase in obtaining information from the patient in the first couple of minutes than before using the guide.   
>> 
>> My point is ... I don't believe that we will ever be able to stop errors from occurring, similar to we will never stop car accidents from happening, however, as we remain open to opportunities for small changes, like seat belts, we can continue to minimize the risks. Small changes can have big impacts. 
>> 
>> 
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