***SPAM*** Re: [IMPROVEDX] Crowd Wisdom, Premature psych conclusions, and harm from misdiagnosis

xavier prida xprida at BAYHEARTGROUP.COM
Fri Jul 26 12:13:19 UTC 2013

Whether it be cognitive or visual learning or both(clinicians often need
integrate both) I happened upon this piece in of all sources, Sports
Illustrated, elucidating the concept of "chunking". Performance(athletic or
otherwise) is dependent on a trained mind and imagery with contextual
organization. Copy and paste link below:


On Thu, Jul 25, 2013 at 8:10 PM, Graber, Mark <Mark.Graber at va.gov> wrote:

> Deborah's stories, tragic as they are, convey an incredibly important
> lesson for all of us interested in diagnostic error - namely that being
> more aware of the possibility of diagnostic error can help prevent the next
> one.  Acknowledging that this is an 'n' of 1 demonstration, its still great
> to hear that building awareness had an impact.
> Pat Croskerry has argued in several of his papers that one way to reduce
> diagnostic error is to teach the inherent shortcomings of heuristic
> thinking.  I was initially unconvinced, on the grounds that these are
> hardwired responses, and can't be unlearned.  Deborah's ability to discover
> a new diagnostic error would seem to argue that we should score one in
> Pat's favor, although I wonder what was the more dominant influence for
> Deborah: knowledge of cognitive bias, or just knowledge that these errors
> are so common.
> Mark Graber
> Senior Fellow, RTI International
> Founder and President, Society to Improve Diagnosis in Medicine
> ________________________________
> From: "Dr.Will" <dr.will at FUSE.NET>
> Reply-To: Society to Improve Diagnosis in Medicine <
> Date: Thu, 25 Jul 2013 16:32:00 -0400
> Subject: Re: [IMPROVEDX] Crowd Wisdom, Premature psych conclusions, and
> harm from misdiagnosis
> Hello Deborah,
> And then you add additional work the physician must do per patient
> visit(EMR) taking them away from the patient and you end up with a
> "misdiagnosis" because there was very little clinical time spent with the
> patient due to extra work requirements.
> So wrong diagnosis, but an effective billing software system so the
> hospital was paid well. Seemingly at the expense of the patient.
> It happens too frequently.
>  Will Sawyer, MD
> Solo Family Medicine
> Cincinnati, Ohio
> ________________________________
> From: Deborah Akinniyi [mailto:deborah.akinniyi at YALE.EDU]
> Sent: Thursday, July 25, 2013 2:11 PM
> Subject: Re: [IMPROVEDX] Crowd Wisdom, Premature psych conclusions, and
> harm from misdiagnosis
> Hello everyone,
> My name is Deborah Akinniyi, and I'm an internal medicine resident who
> became interested in diagnostic error during my third year of medical
> school after my first patient died... When he died, I wept... and I was
> angry. My team said there was nothing we could do, that these things
> happen, and that with patients like him the outcome wasn't surprising. I
> didn't accept these notions, because deep inside, a gnawing feeling told me
> we were wrong; despite the type of patient he was, or the psychiatric and
> medical comorbidities he had, his death could have been prevented.
> These feelings pulled and pushed me towards careful review of his case,
> acceptance that even the most seasoned doctors make mistakes, and my
> introduction to diagnostic error. I confirmed that we were wrong, and found
> that my patient's story was an unfortunate case of delayed diagnosis,
> cognitive biases, and diagnostic error proved deadly. Since then, I've
> remained interested in reducing diagnostic error through various means,
> including sharing my experiences with other physicians so that we can all
> learn from it.
> I have a case of a patient who was being "dismissed as psych" so strongly
> that her inspiratory chest pain, palpitations, and sinus tachycardia were
> dismissed as consequences of her pre-existing psychiatric disorders. Prior
> to coming on service, I was told that she was completely fine, had no
> current medical issues, and was just waiting for an inpatient psych bed. I
> was told, "Don't be alarmed if she complains of chest pain... It's just the
> way her anxiety presents." I was even given specific instructions not to
> pursue a pulmonary embolism (PE) work-up... "She does not have a PE."
> It turns out, this patient had multiple PE's. She also had a personal
> history of spontaneous abortions, and a family history of blood clots.
> Later, we confirmed that in addition to her pre-existing psychiatric
> disorders, she has a genetic clotting disorder.
> When I reflect on this case, I'm forced to realize that had I not been
> aware of how common various biases can lead to delayed diagnosis and
> diagnostic error, this woman may have continued to go untreated, worsening
> her physical health, and her concerns may have continued to be minimized
> and dismissed, worsening her mental health. I also suspect that patients
> with pre-existing psychiatric disorders likely suffer from delayed and
> misdiagnosis more commonly, and agree that the implications this has on the
> financial burden, patient safety, mental health, physical health, and the
> overall doctor-patient relationship in this group are frightening.
> I plan to fully analyze this case from a diagnostic error standpoint and
> to review the literature on the specific biases that affect the care of
> patients with pre-existing psychiatric disorders. I plan to eventually
> write a case report on this, and am sure that through that process, I'll
> learn even more about diagnostic error and how to prevent it. If any of you
> have experiences, articles, or papers you'd like to share, please send them
> my way! Also, if you have any questions for me, or any advice to help me as
> I continue through residency and develop as a physician, I'm all ears and
> open for mentorship. I'm inspired by you all, and I look forward to
> continuing these conversations.
> Sincerely,
> Deborah Akinniyi
> Deborah C. Akinniyi, MD, MS
> Yale Internal Medicine Residency Program
> MD, George Washington University, '12
> MS/BS, Stanford University, '08
> Website: http://fickprinciple.wordpress.com
> Email: deborah.akinniyi at yale.edu, chinenye at stanfordalumni.org
> Confidentiality Note: This e-mail is intended only for the person or
> entity to which it is addressed and may contain information that is
> privileged, confidential or otherwise protected from disclosure.
> Dissemination, distribution or copying of this e-mail or the information
> herein by anyone other than the intended recipient, or an employee or agent
> responsible for delivering the message to the intended recipient, is
> prohibited. If you have received this e-mail in error, please email
> deborah.akinniyi at yale.edu and destroy the original message and all copies.
> On Wed, Jul 24, 2013 at 7:40 PM, James Navin <jnavindr at aol.com> wrote:
> absolutely true there is a reason they screen admitted mental patients for
> thyroid disease and syphilis
> jn
> -----Original Message-----
> From: Amy Reinert <amy.reinert at GMAIL.COM>
> Sent: Wed, Jul 24, 2013 1:36 pm
> Subject: Crowd Wisdom, Premature psych conclusions, and harm from
> misdiagnosis
> I'm coming in a little bit late to this discussion, but did want to
> respond to Dr. Bell's comment about women with history of sexual abuse
> seemingly living in the doctor's office.
> For my doctoral dissertation research, I conducted a study of women
> diagnosed with autoimmune disease whose symptoms had been dismissed by
> several physicians over the course of several years. All of these patients
> were dismissed as "psych" by male and female physicians alike (please note
> that they were screened for pre-existing mental disorders). Some physicians
> ran tests initially. Others declined to run tests at all. Obviously these
> women truly were ill, however, they experienced significant psychological
> harm that can reasonably be attributed to misdiagnosis or lack of
> investigation. Of course, there were also financial implications from all
> of these unproductive office visits. Too much to go into in depth here, but
> in considering the harm these patients experienced in terms of their mental
> health (being told they was nothing wrong with them when in fact their
> bodies were clearly--to them-- ill) and the worsening of their untreated
> disease, it seems that there does need to be further study of patients with
> unresolved symptoms. The results of my study also indicated that more study
> of the influencing "invisible" personal biases held by physicians is also
> in order.
> A.D. Ruzicka, Ph.D
> ________________________________
*Xavier E. Prida MD
Bay Heart Group
813 875 9000 (Ofc)
813 874 3278 (Fax)
xprida at bayheartgroup.com

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