FW: checklist vs. checklist - and engaging patients in the check-up!

Lorri Zipperer Lorri at ZPM1.COM
Sat May 4 15:16:29 UTC 2013

From: Nonie Leonidas [mailto:nonieleonidas68 at gmail.com] 
Sent: Friday, May 03, 2013 5:40 PM
To: Society to Improve Diagnosis in Medicine; Kathryn McDonald
Subject: Re: checklist vs. checklist - and engaging patients in the


Hi Kathyrn,                  (Response is 273 words only.)


I practiced pediatrics (solo) for 37 years at Bangor, Maine. About five
years before I retired in 2008 I created a parentsmedschool.com (no longer
online) whose goal is to educate parents about how we arrive at a diagnosis.


One of the section is "Questions that pediatricians should ask if their
child has chronic headache, abdominal pain, prolonged fever, etc." I
requested parents to print and answer these questions before coming to the


For chonic belly pain I have 15 questions answered mostly by YES or NO that
I created. 


I trained my nursing assistants to ask these questions using AmazingChart
EMR. These are the same questions at the website for parents.


When I come in to examing my patient, I just review that PRESENT ILLNESS
window with all of the 15 questions already answered.


At the diagnosis field, I just write Chronic Abdominal Pain and if I want
the differential Dx, another click I will have all of the causes of chronic
bely pain in children whose top five are the most serious with treatment,
unlike the textbook-based listing of organ or function systems without
consideration of seriousness.


With this EMR whose fields I have modified, I enjoyed my practice till my
wife forced me to retire.


Now I enjoy giving talks at some University Med School and Medical Centers
in the Philippines on Reducing Diagnostic Errors concentrating on the use of
EMR. I also give talks on How to Have a Happy, Smart Child using Evidence
Based Parenting studies.


I suggest that we study or create a "standard" minimum set of questions for
common and serious problems, and test its effectiveness. I think there is
one study in adult migraine with only few questions and the diagnosis of
migraine is almost certain.


Leonardo L. Leonidas, MD

Assistant Clinical Professor in Pediatrics (retired 2008)

Distinguished Career Teaching Award, 2009

Tufts University School of Medicine, Boston, USA

Author: How to Raise A Happy, Smart Child (an eBook)


Baby Math (an eBook)






On Fri, May 3, 2013 at 4:04 PM, Kathryn McDonald
<Kathryn.McDonald at stanford.edu> wrote:

I am looking forward to hearing input on this question! I'm in the midst of
revising a manuscript based on our last DEM conference and literature about
patient involvement mitigating error during the diagnostic journey, and
would be glad to fold in some information on tools (if you let me know how
to cite it).


Senior Scholar & Executive Director

 Stanford Health Policy (CHP/PCOR)

 <http://healthpolicy.stanford.edu> healthpolicy.stanford.edu |
<http://www.twitter.com/StanfordHP> http://www.twitter.com/StanfordHP

Center for Health Policy, Freeman Spogli Institute for International Studies

Center for Primary Care & Outcomes Research, Stanford School of Medicine
117 Encina Commons, Room 184 | Stanford, CA 94305-6019

 <mailto:kathy.mcdonald at stanford.edu> kathy.mcdonald at stanford.edu| P.
650.723.0559 | F. 650.723.1919  


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