Improving diagnosis - "one size doesn't fit all"

Alan Morris Alan.Morris at IMAIL.ORG
Mon Jan 6 23:51:36 UTC 2014


I question these arguments for the reasons indicated in MY CAPITALIZED COMMENTS EMBEDDED IN Dragica K.Mrkoci'S MESSAGE BELOW
Have  a nice day.

Alan H. Morris, M.D.
Professor of Medicine
Adjunct Prof. of Medical Informatics
University of Utah

Director of Research
Director Urban Central Region Blood Gas and Pulmonary Laboratories
Pulmonary/Critical Care Division
Sorenson Heart & Lung Center - 6th Floor
Intermountain Medical Center
5121 South Cottonwood Street
Murray, Utah  84157-7000, USA

Office Phone: 801-507-4603
Mobile Phone: 801-718-1283
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e-mail: alan.morris at imail.org
e-mail: alanhmorris at gmail.com

From: <Mrkoci>, Dragica <Dragica.Mrkoci at VA.GOV<mailto:Dragica.Mrkoci at VA.GOV>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "Mrkoci, Dragica" <Dragica.Mrkoci at VA.GOV<mailto:Dragica.Mrkoci at VA.GOV>>
Date: Monday, January 6, 2014 11:52 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] Improving diagnosis - "one size doesn't fit all"

I would like to thank our leadership  in Society to Improve Diagnosis in Medicine for the opportunity to be able share our thoughts and our ideas.  The discussion is thought provoking. It has helped all of us who practice medicine to be aware of our role as decision maker on daily basis

Yes we all agree that making diagnosis is complex process  and involves multiple interactions between providers, patients and healthcare system.
I would only mention that most of us are who are clinical educators or supervising  physicians, have additional burden and responsibility to strike a  balance between adequate independence of the trainees and constant  vigilance to assure patient safety and correct diagnosis in timely manner.

"CORRECT DIAGNOSIS" SUGGESTS AN ACCURACY THAT BELIES THE HUMAN COGNITIVE LIMITATIONS OF CLINICIAN DECISION-MAKERS.  FOR MANY SITUATIONS THE CORRECT DIAGNOSIS IS UNKNOWN.  MOST HUMANS OVERESTIMATE THEIR PERFORMANCE (THE "LAKE-WOBEGON" EFFECT).

After practicing medicine for 35+ years in outpatient and inpatient settings (In USA and previously outside USA) I do not see any single approach applicable to all healthcare settings . On the other hand we should strive to utilize every possible approach and every tool available in diagnostic process in order to improve diagnostic accuracy and to decrease number of diagnostic errors. There is place for intuition and analytic reasoning, checklists, decision-support systems and  information technology and others;  our goal better diagnostic accuracy.

I AGREE – THIS IS CLEARLY TRUE WHEN NO EVIDENCE ON WHICH TO BASE A DECISION EXISTS.  HOWEVER, WHEN CREDIBLE EVIDENCE EXISTS, DECISION-SUPPORT TOOLS APPEAR TO LEAD TO BETTER TREATMENT (MORE CLOSELY LINKED TO BEST EVIDENCE) THAN DO UNAIDED CLINICIANS.

As a Society, we should try to sort out which of the  available tools/ideas could be applicable in different health care settings (inpatient, outpatient, diagnostic medicine, consult medicine etc.), and potentially result in improved diagnostic accuracy in particular setting.

More thoughts in

Diagnostic Error - Mini Review ...<http://benthamscience.com/open/tounj/articles/V006/31TOUNJ.pdf>benthamscience.com/open/tounj/articles/V006/31TOUNJ.pdf

Dragica

Dragica K.Mrkoci, M.D., FACP
Hospitalist Internal Medicine
VA Site Medicine Subinternship Director
Assistant Professor of Medicine George Washington University
Assistant Professor of Medicine, Uniformed Services University of the Health Sciences
Department of Veterans Affairs, Medical Service
50 Irving Street, NW, Washington, DC  20422
(202) 745-8000 # 4995 office
Dragica.Mrkoci at va.gov<mailto:Dragica.Mrkoci at va.gov>


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