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

Bob Latino blatino at RELIABILITY.COM
Wed Dec 18 19:31:50 UTC 2013

Where is the point when it is more reckless to make a decision given the limited and uncertainty of the information provided?  Under such circumstances how is it weighed in the decision-maker's mind that the action taken could make things worse (e.g. - 3 Mile Island)?

The questions below are just meant to evaluate the capability of the decision-maker irrespective of the integrity and accuracy of the information at hand.  This is standard practice when investigating incidents where judgment calls are at play.  Of course this has the luxury being able to review in hindsight.

No matter where these decision-makers work (e.g. - hc, nuclear, refining, pilots, etc.), there is a juncture at which a judgment is to be made as to do something (and what) or not. At this point there is a decision-maker and there is information they are processing.  What is it about the person who gets it right, is different than the person who did not?

Do we normally appropriately consider the potential negative consequences of our decisions?

Robert (Bob) J. Latino
Reliability Center, Inc., P.O. Box 1421, Hopewell, VA  23860
(O) 804.458.0645  (F) 804.452.2119
blatino at<mailto:blatino at> l<>

From: Lorri Zipperer [mailto:Lorri at ZPM1.COM]
Sent: Tuesday, December 17, 2013 12:41 PM
Subject: Re: [IMPROVEDX] Error Rates: Diagnosis--neither numerator nor denominator is known // Bob's questions

re-posted for by the moderator for:
Ross Koppel rkoppel at<mailto: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 qualifications.

> =-=-=-
> (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 decision?
> Did the decision-maker have low alertness due to illness, fatigue or boredom?

Ross Koppel, Ph.D., FACMI
Sociology Dept and School of Medicine
University of Pennsylvania
Ross Koppel <rkoppel at<mailto:rkoppel at>>



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