Addressing several issues

Vic Nicholls nichollsvi2 at GMAIL.COM
Sun Apr 27 12:11:49 UTC 2014

Thank you for this. I'm perusing it and would love to see this go to 
some risk managers and board members I know of.

On the quick ? email, Dr. Prida did a great list of cognitive, 
interpretive, and then system. I was able to put most everything I've 
seen in there.

Dr. Mittal, "The problem of hindsight bias in these studies, however, 
may make front line clinicians resistant to accept their conclusions." 
The problem is that we can come back to a "heart" issue. It doesn't 
matter whether or not its hindsight: when the issue to help a colleague 
grow and learn, maybe stay out of the courtroom or public eye, and to 
help get a patient better, why is there a problem?

I have complained before and I stated I was NOT interested in the doctor 
getting nailed for it but I expected that they help the doctor out. They 
didn't, they nailed ME for complaining. The doctor still has their title 
and they hired help for the doctor. I have no care.

Dr. Graber, on "I certainly acknowledge the costs and harm from 
over-diagnosis, but would argue that an explosion of studies on 
diagnostic error (under-diagnosis) is exactly what's needed right now to 
understand how to improve the efficiency and quality of diagnosis." what 
about patient reporting? When we have to go from doctor to doctor to get 
diagnosed, it would be worth it to have that trail for them to review. 
Everyone can get helped then. Not only that, but when we build decision 
making centers like Watson, they learn and can help the next generation 
of doctors learn.

My big concern with some of this here is the emphasis on fault. If it is 
the doctors fault, then help them. There needs to be a lot more support 
from doctors for doctors in terms of fixing the mistakes and learning 
rather than running from them and blaming a person for being human. Yes 
these mistakes can cause all sorts of problems to death. Be you have to 
face that fact when you become a doctor and learn to deal with it - and 
I don't mean by running to lawyers every time something happens. Run to 
a minister or pastor or whatever and act human. You might find we could 
get along better and there be less problems, as I've known doctors who 
do take it to heart (along with those who don't). For never events, yes 
you have to expect something then, but truly look at the reports and 
you'll find most patients are not sueing their doctors, they're 
complaining more about the issues themselves: including the culture of 

"The medical profession is an honorable one, but at times too protective 
of its fellow physicians---and it is only in the most extreme cases of 
negligence that remedial action is taken. The public requires greater 
vigilance in the licensing of physicians who perform specialized surgery 
to ensure that they have the necessary qualifications and track record 
to be permitted to operate on patients." 
"The profession has refused to aggressively restructure, shorten, and 
improve medical education to meet the needs of today's primary care 
patients. And so the market has, in effect, relieved it of that 
responsibility. Many have cited reduced professional standards and 
compromised clinician quality, both unfounded assertions, as reasons to 
not change the process by which physicians are trained. But professional 
vanity and blind loyalty to tradition, the same egotism that leads some 
to look down their noses at nurse practitioners, are more likely the 
culprits. And the profession will pay dearly for its continued hubris.

Diagnosing disease, dispensing medical advice, and prescribing 
medication, activities once exclusively reserved for physicians, have 
increasingly become the purview of numerous other "providers." And a 
dangerous precedent has therefore been set, one intended to prove that 
medicine can be practiced without physicians, that pieces of their job 
description, critical ones, can be easily reassigned to others. Allowing 
that precedent to take hold will further fragment patient care, ensure 
decreased autonomy, exert downward pressure on compensation, and promote 
enough infighting to guarantee that no collective voice opposes 
corporate or government interests."

What part can medicine and the culture work these things out and then 
what part can patients play to help get things right for doctors, when 
they get retaliated against for trying to help?


On 4/25/2014 9:37 AM, Eric Anderson wrote:
> Attached is an article authored by Dr. Graber that was published in 
> the First Quarter 2014 issue of /Inside Medical Liability/.  This 
> includes practical tips on how physician practices and healthcare 
> systems can minimize the likelihood of misdiagnosis and also includes 
> data from our own closed claims database.  You may find this to be of 
> interest.

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