Ideas on improving rates of missed/delayed diagnoses in PCP type visits.
Lorri at ZPM1.COM
Tue Jan 21 18:51:43 UTC 2014
From: robert bell [mailto:rmsbell at esedona.net]
Sent: Tuesday, January 21, 2014 11:37 AM
To: Society to Improve Diagnosis in Medicine
Subject: Re: [IMPROVEDX] [EXTERNAL] Re: [IMPROVEDX] Ideas on improving rates
of missed/delayed diagnoses in PCP type visits.
Mark, looking in depth at the wrong diagnoses in the 95% is likely to to
identify some things that stand out. Could be anything from a long history,
to a fever, to a fast pulse rate, to borderline lab work, to employment
history, etc. that would alert us to be a little more careful in certain
areas. I would not be surprised if already ED doctors had better skills in
this area than those of office care, where commonality would dull the
So again back to studies.
This SHOULD be the organizations top priority. And I hate using the word
On Jan 21, 2014, at 10:25 AM, Graber, Mark <Mark.Graber at VA.GOV> wrote:
> Yes, Bob has hit the nail on the head. The studies that have looked at
this question find that clinicians are not able to reliably distinguish
which of their diagnoses are correct.
> Most of us would acknowledge, as Minoj points out below, that the vast
majority (say 95%) of new cases seen are common conditions that are quickly
recognized. The other 5 are tricky, and we appropriately take more time
with these, may seek advice or additional information from diagnostic tests.
> Which group is more likely to suffer a diagnostic error? The 95% that are
diagnosed quickly and easily will contain cases that, even though we are
confident of the diagnosis, will be wrong. And the 5% that are hard will
necessarily lead to problems as well, just because they are hard.
> All we can say right now is that the approaches to error reduction will
probably be very different in these two situations and that we don't have a
good way to identify the wrong diagnoses out of the 95% group. Seems like
we either need a better way to find these, and in the meantime to adopt a
strategy where EVERY diagnosis gets reviewed, or close follow-up if the
outcome is important.
> From: "Swerlick, Robert A" <rswerli at EMORY.EDU>
> Reply-To: Society to Improve Diagnosis in Medicine
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Swerlick, Robert A"
> <rswerli at EMORY.EDU>
> Date: Tue, 21 Jan 2014 10:33:51 -0500
> To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: [EXTERNAL] Re: [IMPROVEDX] Ideas on improving rates of
missed/delayed diagnoses in PCP type visits.
> I agree that in busy clinical circumstances it may be difficult to find
the time to go through a Bayesian approach to every clinical problem.
However, how easy is it to identify which cases you need to be more
deliberate? I suspect that diagnostic errors happen when clinicians are very
confident that they have the right diagnosis.
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