Errors in Oncology Pathologies

James Navin jnavindr at AOL.COM
Tue Aug 13 23:31:02 UTC 2013


I was trained to look at slides originally  without the history--reserving the right to change when I had all the info. A fellow resident always perferred to have the info up front. over the years serious errors occurred more often with his approach. 
of course you have to be able to accept that you can make errors with inadequate info but once you arrive there significant eror reduction can be obtained--some egos do not allow this approach--But just remember you ae there to serve the patient.

jimn


-----Original Message-----
From: Robert Bell <rmsbell at ESEDONA.NET>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Tue, Aug 13, 2013 12:39 pm
Subject: Re: [IMPROVEDX] Errors in Oncology Pathologies


Good point Mark.

Would symptoms only and other "tests" work better?

Rob Bell

Sent from my iPad

On Aug 13, 2013, at 1:50 PM, "Graber, Mark" <Mark.Graber at VA.GOV> wrote:

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

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