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

Edita Falco edita.falco at GMAIL.COM
Thu Aug 21 21:06:46 UTC 2014


Dear Dr Jain
i cannot but totally agree with you  *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*
As a pediatric surgeon i was used to receive late diagnosis of
intutusseption as the pediatricians misinterpreted early symptoms as
neurological issues-vomiting and depression-not to talk about early
diagnosis of neuroblastoma and other pelvic tumors ..constipation produced
by extrinsic
compression of the rectum was never consdered.text books need an upgrade
dra falco
montevideo
uruguay



On Thu, Aug 21, 2014 at 7:49 AM, Jain, Bimal P.,M.D. <BJAIN at partners.org>
wrote:

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