Diagnostic Error as Major Issue in Healthcare reported in ECRI and ASHRM Today

Duke Okes dokes at EARTHLINK.NET
Sun Aug 17 16:27:37 UTC 2014


Here's an organization that has a major focus on embedding critical 
thinking in education: http://www.criticalthinking.org/

Perhaps they would welcome the opportunity to work with the medical 
profession.

Duke


On 8/17/2014 11:18 AM, Bob Latino wrote:
> Hi Rob
>
> Spot on as usual!
>
> I teach critical thinking skills and have tried for years to get such 
> skills into grade school, under-grad and grad level academia.
>
> I have learned a lot about how academia works. Trying to overcome the 
> hurdles of tenure and regulatory compliance (SOL's) to ensure federal 
> monies, was not worth the exhaustive effort to do what I know to be right.
>
> Here is an attempt where I worked with a bright 5th grader to do a 
> root cause analysis (critical thinking) on bullying.  It was a great 
> experience for me to prove that even a 5th grader could do a proper 
> RCA with minimal training.
>
> https://m.youtube.com/watch?v=edCaOuWxqqw&list=PL343019FE5B302782
>
> I presented this with the 5th grader to a elementary, middle and 
> gifted high school principal. I received a response that was 
> equivalent to 'our kids already learn this type of skill as a part of 
> the mandatory government requirements'. They had no clue about the 
> real working world!
>
> They were not willing to go outside the boundaries of minimal 
> requirements to try and change the curriculum.
>
> Even engineering schools do not all teach such skills.
>
> Why do we have to wait for students to get into the workplace, learn 
> OJT (on the job, and often wrong), and then experience bad outcomes 
> before we do something about it?
>
> I am open to help get such skills in academia, if anyone has more 
> patience than I with how to navigate the politics.
>
> Bob
> Sent from my iPhone
>
> On Aug 17, 2014, at 10:37 AM, "robert bell" <rmsbell at ESEDONA.NET 
> <mailto:rmsbell at ESEDONA.NET>> wrote:
>
>> Thanks Pat,
>>
>> I totally agree.
>>
>> A much heavier emphasis on critical thinking 
>> [http://en.wikipedia.org/wiki/Critical_thinking] at every level of 
>> education (kindergarten, grade school, college, med school and after) 
>> would be of immense be value.
>>
>> Congress might even agree on a few more things!
>>
>> How does one arrange this in education at all levels?
>>
>> Rob Bell
>> On Aug 16, 2014, at 2:06 PM, Pat Croskerry <croskerry at EASTLINK.CA 
>> <mailto:croskerry at EASTLINK.CA>> wrote:
>>
>>> Agreed that a major transition is going on in medicine. Much of it 
>>> good – immediately accessible knowledge at the touch of a button and 
>>> less reliance on the fallibilities of human memory. But studies on 
>>> diagnostic failure show that knowledge deficits are not the major 
>>> issue – it is how clinicians think about diagnosis. The complexity 
>>> of the interface with the patient is invariably underestimated and 
>>> to imagine that computers will be a panacea is wishful at best. At 
>>> worst, increasing dependency on mobile technologies by off-loading 
>>> cognitive operations will likely compound our problems. There is a 
>>> distinction to be made between those who are ‘uncomfortable’ with 
>>> computers and those who can appreciate the unintended consequences 
>>> of over-reliance on technology.
>>> In the good old days, I don’t recall ever being taught about 
>>> decision making and how bias could affect my clinical judgment – 
>>> certainly there was no mention of ‘cognitive debiasing’. These are 
>>> all fairly recent innovations. The evidence is now very clear that 
>>> dramatic improvements in problem solving can be achieved using 
>>> critical thinking training. More than ever before, we need to be 
>>> graduating physicians who can think critically – it won’t be the 
>>> answer to all the problems in diagnostic failure, but it will help 
>>> in a significant way.
>>> Pat
>>> *From:*Art Papier [mailto:apapier at LOGICALIMAGES.COM]
>>> *Sent:*Thursday, August 14, 2014 10:21 PM
>>> *To:*IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
>>> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>>> *Subject:*Re: [IMPROVEDX] Diagnostic Error as Major Issue in 
>>> Healthcare reported in ECRI and ASHRM Today
>>> Mike- Also another liability company is engaged and moving on 
>>> diagnostic errors with innovative programs.  Coverys, a Boston 
>>> headquartered liability company is offering a liability premium 
>>> discount to those insured physicians that they insure to use 
>>> VisualDx diagnostic CDS.  Coverys has also certified VisualDx for 
>>> point-of-care CME.  Geri Amori, PhD, ARM, CPHRM, DFASHRM, Vice 
>>> President, Academic Affairs for Coverys will be attending DEM.  I am 
>>> sure those with interest in the role of liability insurers will 
>>> enjoy connecting with Geri at the meeting.
>>> Excuse the length, but here is some additional musings on CME:
>>> There are new ways to think about CME.  Traditional CME of sitting 
>>> in lectures or online activities that try to implant knowledge in 
>>> the brain suggest that physician can hold what is needed for their 
>>> future patients in the brain, synthesize that knowledge and then ask 
>>> the right questions every 20 minutes when each patients present with 
>>> a diverse array of problems and symptoms in their offices or 
>>> emergency rooms. Most know this is impossible to do reliably. We are 
>>> currently living through a historical transition in medicine, making 
>>> us the last profession to use computing to aide cognition.  Every 
>>> other profession started using computing on a wide scale much 
>>> earlier than medicine.  We are in the midst of this transition, so 
>>> some don’t recognize how fundamental the shift is.  My residents use 
>>> their smart phones and desktop computers to access knowledge all the 
>>> time.  That is a huge change from when I went to medical school.  We 
>>> were expected to recite differentials from our heads.  The next wave 
>>> will include much more intelligent systems, and knowledge frameworks 
>>> will begin to standardize the adhoc chaos that memory based care has 
>>> wrought.  We are moving from a memory based educational paradigm, to 
>>> an memory assisted and augmented paradigm.  Larry Weed has written 
>>> so eloquently about how the unaided mind cannot do what is needed.  
>>> Whether you agree with Larry’s premise and solution of Problem 
>>> Knowledge Couplers or not, I recommend that anyone that is thinking 
>>> about medical education and medical decision making should read his 
>>> book Medicine in Denial and his recent paper in Diagnosis.  I know 
>>> there are many on this listserv that watch their children work with 
>>> computers and on their smartphones with amazement, and are not truly 
>>> comfortable themselves with computers.  I have found that many 
>>> experienced clinicians and clinical educators from my generation 
>>> have a suspicion of computing, erroneously believing that poorly 
>>> designed electronic health records represents medical 
>>> computing. They see the problem with electronic records and believe 
>>> that it is a bleak future.  A future of doctors staring at screens 
>>> and not talking to the patient.   They believe computing in itself 
>>>  is actually driving this wedge between the patient and physician, 
>>> and that if we could just return to the good old days and just teach 
>>> students in some ideal way, “cognitively debias them”, teach them 
>>> about decision-making,  and then the problem of diagnostic errors is 
>>> solved..presto! done.   We are late to the game, but the good news 
>>> is that medicine will change.  It’s second nature to our students 
>>> and residents and they will advance change and we will advance 
>>> systems that assist us and the patients directly.
>>> Best Art
>>> Art Papier, MD
>>> Chief Executive Officer
>>> 585.272.2630 |apapier at logicalimages.com 
>>> <mailto:apapier at logicalimages.com>
>>> ______________________________
>>> <image001.png>
>>> www.visualdx.com <http://www.visualdx.com/>
>>> Associate Professor
>>> University of Rochester College of Medicine
>>> *From:*Michael Grossman [mailto:Michael.Grossman at MIHS.ORG]
>>> *Sent:*Thursday, August 14, 2014 5:31 PM
>>> *To:*IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
>>> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>>> *Subject:*Re: [IMPROVEDX] Diagnostic Error as Major Issue in 
>>> Healthcare reported in ECRI and ASHRM Today
>>> Actually insurance companies are at increased risk to lose money if 
>>> diagnostic errors are not addressed. Many of the insurance companies 
>>> actually present CME courses based on their actuarial experience and 
>>> present data on causation of common mal practice claims. The MICA in 
>>> Arizona also gives a discounted rate to those practitioners who 
>>> attend these meetings.
>>> I am not aware of any presentations regarding errors in medical 
>>> diagnosis
>>> Michael Grossman , MD MACP
>>> *From:*Vic Nicholls [mailto:nichollsvi2 at GMAIL.COM]
>>> *Sent:*Thursday, August 14, 2014 2:19 PM
>>> *To:*IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
>>> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>>> *Subject:*Re: [IMPROVEDX] Diagnostic Error as Major Issue in 
>>> Healthcare reported in ECRI and ASHRM Today
>>>
>>> Money.
>>>
>>> Follow the money.
>>>
>>> Victoria
>>>
>>> On 8/14/2014 12:21 PM, Rob Bell wrote:
>>>
>>>     I have never completely understood why the insurance industry
>>>     has not led the patient safety movement. Anyone know?
>>>     Rob Bell
>>>
>>>     Sent from my iPhone
>>>
>>>
>>>     On Aug 14, 2014, at 8:27 AM, Jason Maude
>>>     <Jason.Maude at ISABELHEALTHCARE.COM
>>>     <mailto:Jason.Maude at ISABELHEALTHCARE.COM>> wrote:
>>>
>>>         Ruth
>>>         Many thanks for this.
>>>         To add to the risk/malpractice view, MMIC (the largest
>>>         policyholder-owned medical liability insurance company in
>>>         the Midwest) has dedicated the latest issue of its Brink
>>>         Risk Solutions magazine (Summer 2014) to diagnosis. You can
>>>         download it from this link
>>>         http://www.mmicgroup.com/pdf/MMIC_BrinkMagazine_2014%20Summer.pdf
>>>         Regards
>>>         Jason
>>>         Jason Maude
>>>         Founder and CEO Isabel Healthcare
>>>         Tel: +44 1428 644886
>>>         Tel: +1 703 879 1890
>>>         www.isabelhealthcare.com <http://www.isabelhealthcare.com/>
>>>         *From:*Ruth Ryan <rryan at LAMMICO.COM <mailto:rryan at LAMMICO.COM>>
>>>         *Reply-To:*Society to Improve Diagnosis in Medicine
>>>         <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>>         <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Ruth Ryan
>>>         <rryan at LAMMICO.COM <mailto:rryan at LAMMICO.COM>>
>>>         *Date:*Wednesday, 13 August 2014 20:03
>>>         *To:*"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>>         <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>"
>>>         <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>>         <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
>>>         *Subject:*[IMPROVEDX] Diagnostic Error as Major Issue in
>>>         Healthcare reported in ECRI and ASHRM Today
>>>
>>>         Sadly, hospitals and hospital risk managers have been mostly
>>>         absent from discussion or action on diagnostic error in
>>>         medicine.
>>>
>>>         There are signs this may be changing.
>>>
>>>         Today ECRI published a short article titled,“The
>>>         Difficulties in Defining and Preventing Diagnostic Errors”.
>>>
>>>         Subscribers may link to ECRI Institute Healthcare Risk
>>>         Alerts atwww.ecri.org <http://www.ecri.org/>
>>>
>>>         The ECRI article references another article in the July
>>>         issue of/Journal of Healthcare Risk Management/, a
>>>         publication of ASHRM, the Association of Healthcare Risk
>>>         Managers, which came into being with the assistance of the
>>>         American Hospital Association.
>>>
>>>
>>>           The/Journal of Healthcare Risk Mgt/article is titled
>>>           “Diagnostic error: Untapped potential for improving
>>>           patient safety?” The abstract may be viewed
>>>           athttp://onlinelibrary.wiley.com/enhanced/doi/10.1002/jhrm.21149/
>>>
>>>         Ruth
>>>         Ruth Ryan RN, BSN, MSW, CPHRM
>>>         Senior Risk Management Education Specialist
>>>         LAMMICO
>>>         1 Galleria Blvd., Suite 700
>>>         Metairie, LA 70001
>>>         E-Mailrryan at lammico.com <mailto:rryan at lammico.com>
>>>         Telephone (504) 841-2736
>>>         Fax (504) 841-5312
>>>
>>>         ------------------------------------------------------------------------
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>>> Communication co-chair, Society for Improving Diagnosis in Medicine
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>>
>>
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>>
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>> Moderator: Lorri Zipperer Lorri at ZPM1.com <mailto:Lorri at ZPM1.com>, 
>> Communication co-chair, Society for Improving Diagnosis in Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>
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> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, 
> Society for Improving Diagnosis in Medicine
>
> To learn more about SIDM visit:
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-- 
Duke Okes
Knowledge Architect
APLOMET
444 Fall Creek Road
Blountville TN 37617-4802 USA
(423) 323-7576








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