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

Vic Nicholls nichollsvi2 at GMAIL.COM
Sat Jan 11 02:02:53 UTC 2014

I wanted to ask about this.

1) Dr. Ruzicka brings up an interesting point. I've gotten a lot of my
medical records and have never once seen (I looked) any differential
diagnoses. I would have been more than happy to look them up/research
them, so that I could see if that was what I had or what I needed to
do/say to resolve that issue. Work with my doctors so that we come to
the right problem and then fix it right. Do physicians not do these any
longer? Do we know why?

2) I can understand that doctors would be leery about newer drugs. What
about diagnoses, signs/symptoms of items? Are they considered on the
same level of "trust" that medical literature on drugs is?

3) Do you, as professionals, ever treat those who are more
clinically/medically educated vs. the Oprah (who's the doctor on that
show?) people? I would think that those who are more savvy would
probably be a help. I get the impression that isn't so. Can you all
explain why? There are many of us who are thinking we're doing you all a
favor, but I'm getting the impression we're not.

Thank you to all the professionals who give of your time so that we can
come together and figure out what we can do to make things better for
the profession, future professionals, and the patients.

All without lawyers ... who I think can be just as much irritaters of
the rectal canal to us at times as they can to medical professionals.


On 1/10/2014 11:43 AM, Amy Reinert wrote:
> The "rule out" diagnosis used in the five axis diagnostic system is
> very effective in raising a flag that is understood to mean that there
> is enough evidence present to suspect a disorder, but more information
> is needed to reach a firm conclusion. This leaves room open for
> another clinician to reach a different diagnosis (interpret evidence
> differently), or to later retract the diagnosis without leaving a
> record that can later be open to misinterpretation.
> Interdisciplinary education and awareness generally proves to be
> helpful in advancing knowledge and identifying solutions.
> Victoria's comment above again raises a good point. Not all of the
> problems in US health care are systems related, although there are
> certainly plenty of systems issues to make it seem reasonable to lay
> all of the blame there and not explore other possible sources.
> Victoria has brought forward the reality that the practice of medicine
> is affected by social and cultural factors that influence clinicians,
> both individually and in groups. Factors such as clinician personality
> traits, cognitive bias, elitism, ego, cultural ignorance, power,
> classism-- and all the other -isms, interpersonal dynamics, authority
> status, etc., are often overlooked elements of the container in which
> medicine is practiced, but understanding of the magnitude of their
> effect, for better or worse, cannot be obtained in the laboratory.
> This is where partnering between medical science and the social
> sciences can be helpful in improving care delivery and reducing cost.
> Best,
> Amy Ruzicka, Ph.D.

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