Ten Commandments to Reduce Diagnostic Errors

Ross Koppel rkoppel at SAS.UPENN.EDU
Tue Aug 26 17:25:01 UTC 2014


This is why Harold Lehmann is needed in this world.

Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134

On 8/26/2014 9:30 AM, Harold Lehmann wrote:
> Am I a crab to point out that “First Do No Harm” is false? Because we 
> harm all the time—because we (and hopefully the patient) think it’s 
> worth it. (Asking embarrassing History questions (#)…asking for 
> disrobing…cold stethoscope…rectal exam…gagging pharyngeal exam…blood 
> test…IV…VCUG…bone marrow aspiration…Need I go on?)
>
> So: “First, Do the Least Necessary Harm”?
>
> Also—re "think of serious and treatable conditions and act on them 
> without delay”—does that reward availability bias? Or are we saying 
> that any such “thought” means the likelihood is > 1/1,000, which I 
> have found (in 20 years of eliciting from residents) is the threshold 
> for referring infants to the ED for an LP, and therefore above threshold?
>
> Or should we say: “"think of serious and treatable conditions and act 
> on them without delay, if the likelihood is high enough”
>
> Harold
>
> From: "<Patrice F. Hirning>", <MD>, <MACP>, CPHRM <phirning at UMIA.COM 
> <mailto:phirning at UMIA.COM>>
> Reply-To: Society to Improve Diagnosis in Medicine 
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "Patrice F. Hirning, 
> MD, MACP, CPHRM" <phirning at UMIA.COM <mailto:phirning at UMIA.COM>>
> Date: Monday, August 25, 2014 at 8:52 PM
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" 
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
> Subject: Re: [IMPROVEDX] Ten Commandments to Reduce Diagnostic Errors
>
> What a great list. This should be shared with all medical students, 
> house staff and practicing physicians. I plan to add these to my 
> presentation to physicians about diagnostic error.
>
> Patrice
>
> *Patrice F. Hirning, MD, MACP, CPHRM*
> Medical Director
> UMIA Insurance, Inc.
> 310 East 4500 South, Suite 550
> Salt Lake City, Utah 84107
> Office 801.554.1145
> Fax 801.531.0381
> Toll Free 800.748.4380
> phirning at umia.com <mailto:phirning at umia.com>
>
>
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>
> *From:*Lorri Zipperer [mailto:Lorri at ZPM1.COM]
> *Sent:* Sunday, August 24, 2014 7:13 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject:* [IMPROVEDX] Ten Commandments to Reduce Diagnostic Errors
>
> Forwarded by the moderator:
>
> From Dr. Leonardo Leonidas, Bangor, Maine 20 May 2001  Copyright 2001
>
> Given to his Son Len and Class 2001 Tufts University School of Medicine
>
>    1. Thou shalt First "Do No Harm."
>
>    2. Thou shalt think of serious and treatable conditions and act on 
> them without delay.
>
>    3. Thou shalt remember that Diagnosis is History, History, 
> History.  Then confirm with clinical examination and more History.
>
>    4. Thou shalt request a test only if it will change your plan or 
> help in predicting the outcome.
>
>    5. Thou shalt question "authority" such as your senior residents, 
> attendings, experts, or even National guidelines.
>
>    6.  Thou shalt continue the debate and questioning even though the 
> data is "IN."
>
>    7. Thou shalt maintain a high index of suspicion for uncommon 
> presentations of the common.
>
>    8. Thou shalt recognize your own beliefs, biases, prejudices, and 
> thinking style.
>
>    9. Thou shalt be wary of your hunches and intuitions. It is better 
> to use Evidence Based Medicine.
>
>   10.  Thou shalt have an iPad* or a smartphone in your palm.
>
> *Palm Pilot in the first edition.
>
> Leonardo L. Leonidas, MD
>
> Assistant Clinical Professor in Pediatrics (retired 2008)
>
> Tufts University School of Medicine, Boston, USA
>
> nonieleonidas68 at gmail.com <mailto:nonieleonidas68 at gmail.com> 
> <mailto:nonieleonidas68 at gmail.com>
>
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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
>
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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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> Visit the searchable archives or adjust your subscription at: 
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> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, 
> Society for Improving Diagnosis in Medicine
>
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