[EXTERNAL] [IMPROVEDX] quick ?

Vic Nicholls nichollsvi2 at GMAIL.COM
Thu Apr 24 23:45:12 UTC 2014


Yes and no.

I was complaining of with my legs and went to the urgent care doc in Nov 
2012. He documented in his notes that I had neuropathies that consistent 
with the literature, were happening, due to malnutrition. Fast forward 
now, and all the things happening were explainable. The difference being 
the surgeon who I saw never picked up on them, and it was a consquence 
of his surgery. Another surgeon did, and same thing as the PCP told me 
to go talk with the surgeon. Another doctor said X, Y, Z are going on 
and so dont do this part of what surgeon recommends.

Oh yes, I also today, when stated I was getting hot and running a fever, 
first thing was menopause. I said nope it aint menopause so don't brush 
me off with that one unless you can prove beyond a doubt with medical 
research that I'm in memopause.

Again, this is NOT the way to improve medicine but I don't see people 
addressing either the statement I made earlier or Peggy's here. One of 
the heart and mindset and dismissal of patients' complaints that are 
legitimate.

Victoria

On 4/24/2014 3:27 PM, Peggy Zuckerman wrote:
> This discussion fails to address a big component, that of delayed 
> diagnosis, which delayed treatments, etc. Delayed diagnosis is most 
> likely unmeasureable and thereby cannot exist statistically.  We must 
> never underestimate how this issue adds to and distorts the general 
> statistics surrounding any disease.
>
> Daily, I read of late diagnosis of cancers that present early on in 
> the patient's life, the symptoms of which are ignored or dismissed for 
> mulitple reasons.  These are eventually diagnosed (we assume), at 
> which time the cancer is at a Stage IV, with fewer options, etc.
>
> We women of a certain age are often reassured that any new symptom we 
> report is attributable to menopause or age, even those which are 
> supported by lab tests that in a male would likely be thought more 
> worthy of further review.  Wish I were wrong on this.
>
> Peggy Z
>
>
> On Thu, Apr 24, 2014 at 11:57 AM, robert bell <rmsbell at esedona.net 
> <mailto:rmsbell at esedona.net>> wrote:
>
>     Is that for all radiological evaluations, CT, MRI, standard Xray,
>     hard tissue, soft tissue, breasts, etc., etc?
>
>     Seems low to me.
>
>     Rob Bell
>
>
>
>
>
>     On Apr 23, 2014, at 12:00 PM, Leonard Berlin <lberlin at LIVE.COM
>     <mailto:lberlin at LIVE.COM>> wrote:
>
>>     There are reliable data in the radiologic literature that
>>     indicate that the average error rate among radiologists'
>>     interpretation of radiographic exams is approximately 3%. 
>>     Fortunately, most of these errors are inconsequential clinically.
>>
>>     Lenny
>>
>>     Leonard Berlin, MD, FACR
>>     Radiology Department, Skokie Hospital
>>     Skokie, IL;
>>     Professor of Radiology
>>     Rush University, and
>>     University of Illinois
>>     Chicago, IL
>>
>>
>>
>>     > Date: Wed, 23 Apr 2014 13:32:12 -0400
>>     > From:Mark.Graber at VA.GOV <mailto:Mark.Graber at VA.GOV>
>>     > Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] quick ?
>>     > To:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>     <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>>     >
>>     > Stephen,
>>     >
>>     > We (I) believe the risk of diagnostic error in general medical
>>     settings in the US is in the range of 10 - 15% (Graber. The
>>     Incidence of Diagnostic Error in Medicine; BMJ Qual Saf
>>     2013;22:ii21-ii27. doi:10.1136/bmjqs-2012-001615). That's all
>>     errors, most of which (thankfully) are inconsequential or caught.
>>     The risk of harm is clearly much less and its hard to put a
>>     number on that.
>>     >
>>     > The news stories centered on Hardeep's recent article ( The
>>     frequency of diagnostic errors in outpatient care: estimations
>>     from three large observational studies
>>     > involving US adult populations. Singh H, et al. BMJ Qual Saf
>>     2014;0:1-5. doi:10.1136/bmjqs-2013-002627 <tel:2013-002627>)
>>     where they identified a risk of approximately 5% from chart
>>     reviews in primary care clinics. That number is in the 10-15%
>>     ballpark, given that the approach would have missed errors that
>>     weren't obvious from the medical record, and errors for which the
>>     consequences played out elsewhere, and other methodologic issues.
>>     >
>>     > All of these numbers are based on research approaches. So far,
>>     there aren't any healthcare organizations I know of that are
>>     measuring error rates in real time, and the challenges of
>>     actually doing this are substantial. We have little data on the
>>     error rate for surgical patients, or patients seen in the ER.
>>     There is a great need for research on this question, and for
>>     finding reliable and reproducible ways to find and count these
>>     errors going forward. You can't improve what you can't measure.
>>     >
>>     > Mark
>>     >
>>     > Mark L Graber, MD FACP
>>     > Senior Fellow, RTI International
>>     > Professor Emeritus, SUNY Stony Brook School of Medicine
>>     > Founder and President, Society to Improve Diagnosis in Medicine
>>     > Phone: 919 990-8497 <tel:919%20990-8497>
>>     >
>>     >
>>     > ________________________________
>>     > From: "Pauker, Stephen" <SPauker at TUFTSMEDICALCENTER.ORG
>>     <mailto:SPauker at TUFTSMEDICALCENTER.ORG>>
>>     > Reply-To: Society to Improve Diagnosis in Medicine
>>     <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>     <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "Pauker, Stephen"
>>     <SPauker at TUFTSMEDICALCENTER.ORG
>>     <mailto:SPauker at TUFTSMEDICALCENTER.ORG>>
>>     > Date: Wed, 23 Apr 2014 12:01:55 -0400
>>     > To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>     <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
>>     > Subject: [EXTERNAL] [IMPROVEDX] quick ?
>>     >
>>     > What # is quoted for freq of diag errors in routine practice
>>     > without reference to selection bias??
>>     >
>>     > I think I heard a news story quoting something like 40% of
>>     encounters or patients.
>>     > Hard to believe that # which seems grossly inflated
>>     >
>>     > Steve
>>     > The information in this e-mail is intended only for the person
>>     to whom it is addressed. If you believe this e-mail was sent to
>>     you in error and the e-mail contains patient information, please
>>     contact the Tufts Medical Center HIPAA Hotline at (617) 636-4422
>>     <tel:%28617%29%20636-4422>. If the e-mail was sent to you in
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>>     the sender and properly dispose of the e-mail.
>>     >
>>     > ________________________________
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>>     Communication co-chair, Society for Improving Diagnosis in Medicine
>>
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>     Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair,
>     Society for Improving Diagnosis in Medicine
>
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> -- 
> Peggy Zuckerman
> www.peggyRCC.wordpress.com <http://www.peggyRCC.wordpress.com>
>
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