Ideas on improving rates of missed/delayed diagnoses in PCP type visits.

Nonie Leonidas nonieleonidas68 at GMAIL.COM
Tue Jan 7 01:27:12 UTC 2014

Below is my proposal to our Dean of College of Medicine at University of
the Philippines for consideration:

In the coming 10 to 15 years, most medical students will attend lesser
lecture based teaching program. Instead, after the first year of core
lectures and demonstrations, they will be shadowing residents, fellows, or
consultants of their choice for two to three years until they graduate. It
will be like a “mini-residency” program of their design.

Their board examinations will not be based on multiple choice format of the
20th century. Their test will mostly be oral examinations or actual
patients interview and diagnosis about their area of study. Or it will be a
simulated computerized patient encounter. Just like what pilots do in their
simulators in a cockpit.

Because of the avalance of information and abundance of
randomized-controlled trial studies, traditional teaching methods will not
be able to cope with the transfer of these new information.

Instead, students will learn to do “Just-In-Time” information managment.
Suppose a student is seeing a patient with “wheezing,” with a few taps and
swipe in a iPad or tablet, she or he can easily look at the differential
diagnosis, pertinent questions to ask, phyical findings to look for, and
treatment. There will be even videos of how to listen for wheezing and how
it sounds like as well as the clinical appearance of a patient with
respiratory distress showing the retraction of the inter-costal ribs
correlated with the O2 saturation. The video will feature also how the
treatment is done and the recovery of the patient. At the end of the video
are the references and links in the internet and tips how to reduce medical
errors in the diagnosis and management.

Why is this new format of learning coming to replace the traditional spoon
feeding of canned information? Because of rapid applications of technology,
apps, and new cognitive research findings, faculties of medical schools
will learn soon that their student are happier and smarter if less
traditional teaching are used. Instead, their students will be given more
freedom to study what is interesting and fun for them, and not what
professors want to talk about.

This New educational format might come sooner than you think.

Leonardo L. Leonidas, MD

Assistant Clinical Professor in Pediatrics (retired 2008)

Distinguished Career Teaching Award, 2009

Tufts University School of Medicine, Boston, USA

On Mon, Jan 6, 2014 at 6:57 PM, Alan Morris <Alan.Morris at> wrote:

> I think these pertinent comments address a central deficiency in medical
> research and its funding.
> We have little attention paid to the important issues involved in
> decision-making and outcomes at the patient-clinician encounter scale.
> Note, for example, the absence os significant funding of T3 and T4
> translation research (compared to funding for T1 and T2 translations
> research).
> 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
> Fax: 801-507-4699
> e-mail: alan.morris at
> e-mail: alanhmorris at
> On 1/6/14 11:50 AM, "Vic Nicholls" <nichollsvi2 at GMAIL.COM> wrote:
> >Would a change in medical education to include more EBM, reference
> >clinical tools such as Isobel or UpToDate/ClinicalKey/MDConsult, help
> >with less missed/erroneous diagnoses? Would another method of
> >gathering data from a patient help, in terms of more effective H&P? Would
> >more emphasis on a physical exam vs. tests help?
> >
> >How about a change in testing and what is tested? I know there have been
> >articles out regarding radiology exams, that they appear to focus more on
> >physics and other aspects not related to patient care type issues.
> >
> >Would an emphasis on understanding lab work help? I know I've been able
> >to figure things out by understanding what a test is and what it is
> >looking for.
> >
> >Have doctors ever considered whether patient education would help? If I
> >have a few educated patients, would I be willing to allow them to be more
> >participatory than others? What is the attitude towards medical research
> >brought by a patient?
> >
> >Victoria
> >
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