CANNOT MAKE THE DIAGNOSIS?

Ehud Zamir ezamir at UNIMELB.EDU.AU
Thu Apr 10 03:25:50 UTC 2014


May I add, apart from imprecise diagnostic language, there is sometimes simply insensitive diagnostic language. I cannot forget a young patient I had a few years ago, who was diagnosed with "natural killer T cell lymphoma". I could not think of a worse term to describe a disease. Patients are not biological specimens, and even if that term is biologically accurate, using it in a clinical context is simply insensitive and easily misunderstood as implying the disease itself is a deadly "natural killer" (which it often is, coincidentally, but so are many other diseases we refer to with less macabre terminology). Just one example of how medical language sometimes sounds like it comes out of some ivory tower without much regard to the patient.

There are plenty of other examples of bad diagnostic language. The obvious example in my field is the word "cataract". Very few patients actually understand what that archaic Greek word really means, and most have the misconception that "something is growing on their eye" if you ask them. The descriptive term "cloudy lens" or "lens opacity" (if one wants to sound more sophisticated) would be far more easily understood, for the benefit of patients and doctors alike.

Ehud Zamir



________________________________
From: Swerlick, Robert A [rswerli at EMORY.EDU]
Sent: Thursday, 10 April 2014 6:38 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?


It is hard to know where to start if we want to deal with imprecise diagnostic language. Unfortunately, imprecise language is the rule, not the exception.



Robert A. Swerlick, MD
Alicia Leizman Stonecipher Chair of Dermatology
Professor and Chairman, Department of Dermatology
Emory University School of Medicine
404-727-3669
________________________________
From: robert bell [rmsbell at ESEDONA.NET]
Sent: Wednesday, April 09, 2014 3:15 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

Thanks Alan.

Agree, agree.

Also, it seems to me that the diagnostic definitions are, in the main, proposed by Specialty Societies who MAY be biased for economic reasons. I am not sure if this is the case and would welcome comment. If it is the case, shining lights might help.

The other issue would seem to be that if there is a condition/disease that is not well defined with current parameters would a list of these published by IMPROVEDX be of any value so that others can refine things? After all, looking for Errors in diagnosis becomes hard if there are no good defined diagnostic criteria for certain diseases (which supports your thesis Alan).

Fine, kind, courteous medical/scientific interaction with Specialty Societies would be a great way to grow the organization, impart  the importance of the mission, and make an impact for all!

Position papers could make a big statement.

Rob Bell



On Apr 9, 2014, at 11:23 AM, Alan Morris <Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>> wrote:

Those of you who have paid attention to my past suggestions about standardization might see in this exchange the problems that surface when standards are absent.  Some would assign to chronic renal insufficiency those whom others think normal.
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<mailto:alan.morris at imail.org>
e-mail: alanhmorris at gmail.com<mailto:alanhmorris at gmail.com>

From: Harold Szerlip <hszerlip at GMAIL.COM<mailto:hszerlip at GMAIL.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Harold Szerlip <hszerlip at GMAIL.COM<mailto:hszerlip at GMAIL.COM>>
Date: Wednesday, April 9, 2014 10:03 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

I think you should look at the KDIGO definition of CKD.  CKD 3 A (eGFR 45-60) without proteinuria, which would be the majority of the CKD in the elderly has a minimal increased cardiovascular risk. It is proteinuria that is associated with an increase in risk. This is likely secondary to underlying endothelia dysfunction.  The PREVEND study supports this.

Harold Szerlip, MD, FACP, FCCP, FASN, FNKF

On Apr 9, 2014, at 9:55 AM, Hayward, Rodney (Rod) <rhayward at MED.UMICH.EDU<mailto:rhayward at MED.UMICH.EDU>> wrote:

For the vast majority, the most important implication of CKD is elevated CV risk. In this regard, the current classification is suboptimal in that early stage 3 CKD (eGFR 45-60) only elevates CV risk moderately, but advanced stage 3 (eGFR 30-45) results in a dramatic increase in CV risk.

________________________________
From: Carroll, Thomas [Thomas_Carroll at URMC.ROCHESTER.EDU<mailto:Thomas_Carroll at URMC.ROCHESTER.EDU>]
Sent: Wednesday, April 09, 2014 9:23 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

It seems to me that the definition of CKD (especially in the elderly, but I suppose in everyone) really only matters in the context of an individual’s expected survival.  If they’re very unlikely to outlive their kidney function, then it doesn’t matter and vice versa.

Thomas M. Carroll M.D., Ph.D.
Assistant Professor, General Medicine & Palliative Care
University of Rochester
thomas_carroll at urmc.rochester.edu<mailto:thomas_carroll at urmc.rochester.edu>
Pager 5-1616 #3872
Tel: 585-275-7424 (General Medicine Office)
Tel: 585-273-1154 (Palliative Care Office)

From: robert bell [mailto:rmsbell at ESEDONA.NET]
Sent: Wednesday, April 09, 2014 1:12 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

There are a group of diagnoses where we do not have enough data/information to make a firm diagnosis.

This link relates to age and renal failure  http://www.medscape.com/viewarticle/753447_5[medscape.com]<https://urldefense.proofpoint.com/v1/url?u=http://www.medscape.com/viewarticle/753447_5&k=lmxj0uloiQslubycBXSv7A%3D%3D%0A&r=2K3rpxY%2F727qla%2FHDALAeTaA5t9cwqTMwcT7I%2FCCLB4yjtjSPaS5yPdWSZE2V06X%0A&m=1zYzMxWTkoQiB7gLrE62tYUgQ3O12LX%2BG81cFIbClVs%3D%0A&s=eaf0b349a89245375c2074b66b7706749c53ec585245383530cfd0826a4dfc18>

It is said here: "Therefore, it is not clear to what extent a decline in GFR with age is physiological and what level of GFR should be considered abnormal in older people."

So how can we say some elderly people definitely have Chronic Renal Failure?

So should the first thing be to clarify better what is Chronic Renal failure in elderly people.

Could there be Errors in Diagnosis here because the renal failure standards are incorrect?!

Rob Bell

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