Errors in Oncology Pathologies

James Oldham James.Oldham at SESIAHS.HEALTH.NSW.GOV.AU
Tue Aug 13 21:45:06 UTC 2013


Dear Mark 

Great point. So we may need to define the diagnostic process between path referral and path interpretation, which may be different for many common path requests. (Is is just abnormal histology and imaging that presents this too many alternatives problem?) 

Clinical situation (differential would help) -> path request (how can it help?) -> Path response 

Great discussion

Best wishes

James

James Oldham

Chief Psychiatrist Mental Health Services ISLHN & Clinical Associate Professor University of Wollongong




-----Original Message-----
From: Graber, Mark [mailto:Mark.Graber at VA.GOV] 
Sent: Wednesday, 14 August 2013 6:51 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Errors in Oncology Pathologies

Thanks Jena for corroborating the value of Peggy's advice. I've heard very similar comments from my Radiology colleagues, that supplying clinical information improves their ability to make the right call.

I'm worried though that this may sometimes bias the review and 'frame' the case prematurely.  These kind of framing effects are SO common elsewhere, as illustrated by the Rory Staunton case (His pediatrician communicated to the ER that she was sending over a boy with gastroenteritis, and no surprise that was the ER diagnosis too, missing his sepsis).  So if I send you a lymph node saying 'Pt with weight loss, night sweats, lymphadenopathy, suspected lymphoma', aren't you going to be biased towards a diagnosis of lymphoma by that?

Maybe the better way to frame this is to ask your advice:  How can clinicians best provide clinical information WITHOUT inducing undue bias in the subsequent pathologist's (or radiologist's) diagnosis?

Mark


Mark L Graber, MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook School of Medicine
Founder and President, Society to Improve Diagnosis in Medicine
Phone:   919 990-8497


________________________________
From: Jena Giltnane <jennifer.giltnane at vanderbilt.edu>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Jena Giltnane <jennifer.giltnane at vanderbilt.edu>
Date: Tue, 13 Aug 2013 15:43:56 -0400
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Errors in Oncology Pathologies

Peggy Zuckerman writes, "Clinicians can assist pathologists with more accurate analysis of underlying disease by providing pertinent clinical information and radiologic testing to the pathologists. 4" As a junior pathologist, I am ever so grateful that she included this simple statement. All of the missed and delayed diagnoses I have encountered so far (thankfully, few, but more than I imagined) had a significant component of minimal to no supporting clinical information, or even misleading information. I insist that all of my family and friends get a second oncology and/or pathology opinion when a major treatment decision is based on a limited biopsy. Thankfully, referral pathology is often a "package deal" when a patient seeks a second oncology opinion, and so this may be the best route for patients to pursue. It works best, however, when the pathology material can be received and reviewed with ample time before the patient's visit.

Best regards, Jena
Jennifer M. Giltnane, MD, PhD
Dept. of Pathology, Microbiology, and Immunology
Division of Investigative Pathology
Arteaga Lab @ Vanderbilt University School of Medicine
jennifer.giltnane at vanderbilt.edu












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

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>






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

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>
---------------------------------------------------------------------------------------------

Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children's Hospital Network (Randwick Campus) Confidentiality Notice

This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.

This email message has been virus-scanned. Although no computer viruses were detected, Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children's Hospital Network (Randwick Campus) accept no liability for any consequential damage resulting from email containing any computer viruses.

We care for our environment. Please only print this e-mail if necessary.










More information about the Test mailing list