FM: Crowd Wisdom .... lack of dx error in the curriculum

Graber, Mark Mark.Graber at VA.GOV
Fri Aug 16 13:08:01 UTC 2013


Garry's comments raise a very important and fundamental question in our field that someone out there may know the answer to. If not, add it to the growing list of research priorities:

In the traditional paradigm, the expert evolves from years of training and experience, the 'right' education as Garry phrases it.  The expert becomes so because they've made all the errors there are to make, or have seen them.  The opposing view is that we can shortcut this process if we teach principles of metacognition, present all the cognitive biases and their antidotes, and teach error prevention strategies.  Robin Hogarth has a book "Educating Intuition" and Mark Quirk makes many of the same points in his "Intuition and Metacognition in Medical Education."

The question boils down to whether you believe that you really CAN educate intuition, or do you have to acquire it the 'old fashioned' way, through experience.


________________________________
From: Garry Nieuwkamp <Garry.Nieuwkamp at HEALTH.NSW.GOV.AU>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Garry Nieuwkamp <Garry.Nieuwkamp at HEALTH.NSW.GOV.AU>
Date: Thu, 15 Aug 2013 22:13:51 -0400
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] FM: Crowd Wisdom .... lack of dx error in the curriculum

I have no problems with the lack of error education in medical schools. Everyone wants a part of medical education because this is important or that is important. How about just getting the medical education right and let the other stuff work itself out in due course.
Garry Nieuwkamp MBBS DA FACEM MA PhD

________________________________________
From: Lorri Zipperer [Lorri at ZPM1.COM]
Sent: Friday, 26 July 2013 11:16 AM
To: Garry Nieuwkamp; Society to Improve Diagnosis in Medicine
Subject: [IMPROVEDX] FM: Crowd Wisdom .... lack of dx error in the curriculum

From: robert bell [mailto:rmsbell at esedona.net]
Sent: Thursday, July 25, 2013 5:32 PM
To: Society to Improve Diagnosis in Medicine; Dr.Will
Subject: Re: [IMPROVEDX] Crowd Wisdom, Premature psych conclusions, and harm
from misdiagnosis

[Building on the comments of] Will and Amy,

I think the main problem is that medical diagnosis is not well taught in
medical/PA/NP schools. There are few simulator programs like the airline
industry to repeat things time and time again, little instruction on the
basics of diagnosis and where to get the best help/support, little
instruction on how to get a good history and elicit meaningful symptom
complexes and changes, etc. And little knowledge is passed on as to where
the main errors in diagnosis come from in both the hospital and private
practice offices.

Did I hear that only 50% of teaching schools even address Errors in Medicine
as a whole.

Pretty awful - we are still teaching med students using 100 year old
methods.

Add to this mess to the lack of research in the area and you have one big,
big problem.

This organization could well lobby for more research and medical
training/education in this area.

Rob Bell
On Jul 25, 2013, at 6:51 AM, Dr.Will wrote:


Yes physicians are spending "less time" listening and caring for patients
because of the additional typing responsibilities due to EMR and LESS eye
contact (and if someone does the research), you will see even LESS effective
communication coming out of patient due to the "hurried" office visit. Hence
more "misdiagnosis".
Second there is A LOT of chronic disease that CAUSES depression like
symptoms.
So most physicians should "slow down you're moving too fast, you've got to
let the office visit last(get to the real issue)" to quote a phrase from a
popular song.
 Will Sawyer
Solo Family Medicine


________________________________

From: Amy Reinert [mailto:amy.reinert at GMAIL.COM]
Sent: Wednesday, July 24, 2013 6:58 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
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






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