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

Jason Maude Jason.Maude at ISABELHEALTHCARE.COM
Tue Aug 26 10:58:02 UTC 2014


Bimal

"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."

This is effectively what ddx tools do already for thousands of diseases.
The tools already know the classic and atypical presentations of the
diseases as these have been built into their knowledge bases so when a
clinician enters a set of clinical features it appropriately (whether
classic or atypical) includes the disease in its list. It relieves the
clinician of the burden or rather impossibility of remembering them all.

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/>




On 21/08/2014 11:49, "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
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