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

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Thu Aug 21 10:49:15 UTC 2014


I did not have a chance to comment during John Ely's interesting webinar yesterday as I joined in by telephone. Here are my thoughts about his important study.
1. A major reason for failure to broaden differential diagnosis may be our lack of awareness of the wide variation in clinical presentations of a given disease ranging from highly typical to highly atypical in different patients. This may be due to medical school and textbook teaching which focuses primarily on typical presentations of a disease. Awareness of variation could be increased, I suggest, by looking at summaries of presentations in about one hundred consecutive patients with a given disease seen at a large medical institution. These summaries could be stored in a computer file which could be made available to all interested physicians.

2. An atypical presentation is often interpreted as low pretest evidence due to low pretest probability of a disease which may be ruled out without further testing. I believe, a presentation should be looked upon as a clue to a disease and not pretest evidence which should be ruled in or out by further testing. This would avoid premature closure.

3. The rule of not neglecting base rate is a statistical rule which may not apply in a given, individual patient as we saw in the patient found to have neurosyphilis. I believe it is all right to break this rule by suspecting a rare disease if all other suspected diseases are found not to be present.

4. There is so lttle we know about how diagnosis is performed in actual practice or should be performed to minimize diagnostic errors. I would like to thank John Ely and other investigators who have started to look at diagnosis in actual practice and increase our understanding of this important process.

All the best,

Bimal

Bimal P Jain MD
Pulmonary-Critical Care
NorthShore Medical Center
Lynn MA 01904

-----Original Message-----
From: Ruth Ryan [mailto:rryan at LAMMICO.COM] 
Sent: Tuesday, August 19, 2014 10:01 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Diagnostic Error as Major Issue in Healthcare reported in ECRI and ASHRM Today

Bravo and hats off to you, Jeffery!  If critical thinking skills can be built into the community college program training paramedics in Bossier Parish, North Louisiana, never let it be said such training is ethereal, too difficult, or relevant only to the ivory tower.

Ruth
Ruth Ryan RN, BSN, MSW, CPHRM
Senior Risk Management Education Specialist LAMMICO
1 Galleria Blvd., Suite 700
Metairie, LA 70001
E-Mail rryan at lammico.com
Telephone (504) 841-2736
Fax (504) 841-5312


-----Original Message-----
From: Jeffery Anderson [mailto:janderson at BPCC.EDU]
Sent: Sunday, August 17, 2014 9:26 PM
Subject: Re: Diagnostic Error as Major Issue in Healthcare reported in ECRI and ASHRM Today

I am developing a module on critical thinking for my paramedic program.  Besides using Dr. Croskerry's articles and information from the Foundation for Critical Thinking, I am also using the textbook Patient Safety in Emergency Medicine by Croskerry and Emergency Medicine Decision Making by Weingart as references.  In addition I have been following the work of Dr. Kevin deLaplante of the Critical Thinker Academy.

Jeffery D. Anderson, NREMT-P
Paramedic Program Director
Bossier Parish Community College
Office Phone (318) 678-6403





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Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine

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