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

Dr Wil dr.will at FUSE.NET
Tue Jan 7 01:56:26 UTC 2014


Alan et al
This is why clinicians need scribes so we may take advantage of both human and technological strategies to improve outcomes and consistency. It will help accelerate some research and billing as well.
Will Sawyer,MD

Sent from my iPad

> On Jan 6, 2014, at 6:51 PM, Alan Morris <Alan.Morris at IMAIL.ORG> wrote:
> 
> 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
> Fax: 801-507-4699
> e-mail: alan.morris at imail.org
> e-mail: alanhmorris at gmail.com
> 
> From: <Mrkoci>, Dragica <Dragica.Mrkoci at VA.GOV>
> Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Mrkoci, Dragica" <Dragica.Mrkoci at VA.GOV>
> Date: Monday, January 6, 2014 11:52 AM
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <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 ...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
>  
> 
> 
> 
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> 
> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> 
> 
> 
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> 
> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/








HTML Version:
URL: <../attachments/20140106/8275e116/attachment.html>


More information about the Test mailing list