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

Pat Croskerry croskerry at EASTLINK.CA
Sun Aug 17 18:33:25 UTC 2014


Agreed. When we set up our Critical Thinking program at Dalhousie 2 years
ago we used the Foundation for Critical Thinking as a major resource.

It's an excellent website.

We combined the fundamental tenets of critical thinking with two major
areas: 

1.      Dual process theory to establish the template for critical thinking
in medicine.

2.      Heuristics and biases to cover the influence of bias in clinical
decision making

 

The program has been well received by both students and faculty.

Pat

 

 

 

 

From: Duke Okes [mailto:dokes at EARTHLINK.NET] 
Sent: Sunday, August 17, 2014 1:28 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Diagnostic Error as Major Issue in Healthcare
reported in ECRI and ASHRM Today

 

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
<https://m.youtube.com/watch?v=edCaOuWxqqw&list=PL343019FE5B302782>
&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> 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> 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>
mailto:apapier at LOGICALIMAGES.COM] 
Sent: Thursday, August 14, 2014 10:21 PM
To:  <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
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 |  <mailto:apapier at logicalimages.com> apapier at logicalimages.com

______________________________

<image001.png>

 <http://www.visualdx.com/> www.visualdx.com

 

Associate Professor

University of Rochester College of Medicine

 

From: Michael Grossman [ <mailto:Michael.Grossman at MIHS.ORG>
mailto:Michael.Grossman at MIHS.ORG] 
Sent: Thursday, August 14, 2014 5:31 PM
To:  <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
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>
mailto:nichollsvi2 at GMAIL.COM] 
Sent: Thursday, August 14, 2014 2:19 PM
To:  <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
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 <
<mailto:Jason.Maude at ISABELHEALTHCARE.COM> 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>
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
 <http://www.isabelhealthcare.com/> www.isabelhealthcare.com

 

From: Ruth Ryan < <mailto:rryan at LAMMICO.COM> rryan at LAMMICO.COM>
Reply-To: Society to Improve Diagnosis in Medicine <
<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Ruth Ryan < <mailto:rryan at LAMMICO.COM>
rryan at LAMMICO.COM>
Date: Wednesday, 13 August 2014 20:03
To: " <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
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 at
<http://www.ecri.org/> 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
at  <http://onlinelibrary.wiley.com/enhanced/doi/10.1002/jhrm.21149/>
http://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-Mail  <mailto:rryan at lammico.com> rryan at lammico.com

Telephone (504) 841-2736

Fax (504) 841-5312

 

 

 

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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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