Error Rates: Diagnosis--neither numerator nor denominator is known // Bob's questions

Lorri Zipperer Lorri at ZPM1.COM
Tue Dec 17 17:40:44 UTC 2013

re-posted for by the moderator for: 

Ross Koppel rkoppel at

Dear Members of this interesting discussion.


Your list of questions  (copied below), while entirely reasonable, in my
opinion, misses so much of the reality here by a wide mark. Most of 

the time there's not enough the question about "do you
have all of the info" is almost always "no." and that's

understandable.   One of the things they teach young docs is how to act with
minimal information in minimal time.....and how to know what information
must be collected in a given (often short) time frame. I understand that
when designing a bridge, such questions make no sense. But with a patient
who is getting worse, and when one is not sure why or what the problem is in
the first place, one often feels pressured to act...and rightfully so.    As
to the question of "under stress" or fear of repercussion..... I think we'll
just agree that's life for much of this kind of work.


So, in my opinion (and I'm NOT a physician), the list of questions is not
very helpful.  Also....and now referring to something I do know 

about..... I note that  some of the questions are double barreled questions,
e.g., credentials and qualifications are not the same thing.

20 minutes out of medical school gives one the credentials, but not the




> =-=-=-

> (Bob's questions)

> Did the decision-maker have the adequate credentials and qualifications to
make the correct decision?

> Did the decision-maker have the adequate information in which to make the
correct decision?

> Was the decision-maker under stress (e.g. time pressure) or duress (e.g.
fear of repercussion) which could impair their decision-making process?

> Was the decision-maker over-confident in their ability to make the correct

> Did the decision-maker have low alertness due to illness, fatigue or


Ross Koppel, Ph.D., FACMI

Sociology Dept and School of Medicine

University of Pennsylvania

Ross Koppel <rkoppel at>

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