Errors in Oncology Pathologies

Rob Bell rmsbell at ESEDONA.NET
Thu Aug 15 20:52:22 UTC 2013

Studies are needed - if not already done.

Rob Bell

Sent from my iPhone

On Aug 15, 2013, at 12:55 PM, "Swerlick, Robert A" <rswerli at EMORY.EDU> wrote:

> I have been mulling over this exchange. I actually find the whole idea of the history or clinical information "creating" bias rather odd. Of course it creates bias but it that such a bad thing? Is the influence of history before looking at test data any worse than the influence of test data before you look at other clinical data?
> In my training we were taught to do skin exams before we took any history and I was never convinced that it yielded superior results than knowing the history first.
> As I noted above information can and should bias our judgments. That is the whole purpose of garnering such information, assuming we can avoid premature closure. In my opinion the issues I see in this realm are more driven by inadequate information being used by pathologists than too much. I do not have much interaction with radiologists.
> Bob Swerlick
> -----Original Message-----
> From: Graber, Mark [mailto:Mark.Graber at VA.GOV]
> Sent: Wednesday, August 14, 2013 9:56 AM
> Subject: Re: [IMPROVEDX] Errors in Oncology Pathologies
> I like Ehud's suggested approach too, a lot.  (I copied it just below my message, as it seems to be on a different string at this point).  Reviewing the clinical history AFTER you've performed your first look seems to be an ideal solution.  You avoid the initial possibility of framing and ascertainment bias, you have the chance to incorporate the clinical information, and you enjoy the added benefit of second thoughts -  along the lines of Robert Trowbridge's diagnostic 'time out' concept, or Mamede's 'reflective practice'.
> This would seem to be a great research project (comparing accuracy of diagnosis with first vs last review of clinical data) for someone out there (I'm thinking Jena .......).
> I hadn't really thought about it, but I actually enjoy using Ehud's approach when I do a urinalysis (I'm a Nephrologist). I do the UA first and then try to GUESS the clinical scenario after I see the findings.  It changes the

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