Error Rates: Diagnosis--neither numerator nor denominator is known

Ross Koppel rkoppel at SAS.UPENN.EDU
Mon Dec 16 03:24:58 UTC 2013

Absolutely agree.   The fact that there are many unknowns and systematic 
undercounts (by a factor of 98% some of the time) does not mean we must 
give up.  Exactly as Mark notes, there are many, many ways of breaking 
down the problem and of looking at areas we can examine with greater 
certainty.  More, we can develop ways of measuring and looking that 
improve out current methodologies and theories.

Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134

On 12/15/2013 10:18 AM, Graber, Mark wrote:
> The problem of not being able to count diagnostic errors is one that keeps me up at night.  Ross is correct in describing the fundamental challenges that arise in trying to establish the numerator.  If its true that 'you can't improve what you can't measure', that will leave diagnostic error at the starting gate.
> I've reluctantly come to accept the fact that he is correct - we really CAN'T measure every diagnostic error.  Its not like falls or wrong-site surgery, that are more easily tallied.  But .....  I believe it may be possible to establish a quantitative approach that's not as good as being able to count them all, but may suffice for advancing diagnostic science:
>   *   If we use a specific definition and a defined methodological approach, we should be able to reproducibly count certain types of errors in certain settings.  Example:  delays in diagnosing colon cancer.  We will be able to measure the delays, even if we can't measure all the missed diagnoses
>   *   If we focus on specific steps of the diagnostic process, we should be able to reproducibly count lapses in specific steps.  Example:  how many patients don't have a differential diagnosis listed on their chart;  How many critical alerts aren't addressed in a timely manner.
> Our efforts to reduce diagnostic error will be seriously stymied if we can't come up with at some ways to quantify the current state of affairs and see if interventions have any impact, in a quantitative sense.
> 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

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