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

Alan Morris Alan.Morris at IMAIL.ORG
Wed Jan 8 03:49:38 UTC 2014


Thank you.

"A retrospective Isobel analysis detected my problem by my 20s."


This seems to be an anecdotal example of the value of decision-support
tools - particularly when the clinical problem is unusual or has an
unusual phenotypic expression.

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


On 1/6/14 7:32 PM, "Janel Hopper" <janelhopper at COMCAST.NET> wrote:

>Hi All,
>
>Some might recall that after great delay, I was diagnosed with pernicious
>anemia. I think that a lot of what passes for diagnosis is BS. 5
>hematologists at major institutions now confirm my pernicious anemia. But
>some clinicians can't get their head around it since I wasn't often
>overtly anemic. Members of a major clinic might have trouble admitting
>they were wrong. Easier to call the patient crazy and slap on DXes with
>no laboratory verification. Physicians SAY they are going to work with
>patients who do some of the diagnosis lifting somehow through the
>Internet. My experience is that this is the very rare physician.
>
>They insist on b12 levels and are wholly uninformed about the
>inaccuracies of these tests.
>
>Rather than hypothesize about misdiagnosis in the abstract, I challenge
>any of you to do a post mortem of my 35 year saga. I'm sure other members
>of the Pernicious Anemia Society would also offer up their records.
>
>A retrospective Isobel analysis detected my problem by my 20s.
>
>But the physicians were (and many still are) only willing to consider the
>case through their limited misunderstanding--such as that overt anemia
>must always be present with pernicious anemia. Why check the literature
>since when one is highly confident?
>
>Please feel free to contact me if you are interested in my challenge or
>more details.
>
>Janel
>
>Sent from my iPhone
>
>> On Jan 6, 2014, at 10:50 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
>> 
>> 
>> 
>> 
>> 
>> 
>> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair,
>>Society for Improving Diagnosis in Medicine
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