Ten Commandments to Reduce Diagnostic Errors

Pauker, Stephen SPauker at TUFTSMEDICALCENTER.ORG
Tue Aug 26 17:11:55 UTC 2014


Well now, Dr Crab, one can craft similar prolems

With every (any) commandment or rule.

 

 

Rule 1: Every rule has exceptions. (Yes, but)

Rule 2: Uncertainty and variation are not going away. (So manage them)

Rule 3: Although History was important, it pales at the autopsy (or is
it the MRI)

Rule 4: Since history is a kind of test, testing only if it will change
plans,

             Is not an enforceable rule.

Rule 5: Publication is merely telling a convincing story to reviewers.
(What  makes evidence?)

Rule 6: In a pinch, a brain outsmarts an iPad.

Rule 7: Be wary of Intuition and "Evidence."

Rule 8: Although the uncommon can be important, Prevalence and Bayes
Rule triumphs.

Rule 9: Don't ignore System I thinking (gut feelings)

Rule 10: It's only a guideline."

 

Steve ;-)

 

From: Harold Lehmann [mailto:lehmann at JHMI.EDU] 
Sent: Tuesday, August 26, 2014 9:30 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Ten Commandments to Reduce Diagnostic Errors

 

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>
Reply-To: Society to Improve Diagnosis in Medicine
<IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Patrice F. Hirning, MD, MACP,
CPHRM" <phirning at UMIA.COM>
Date: Monday, August 25, 2014 at 8:52 PM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG"
<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

	

 

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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
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>

 

 

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

To learn more about SIDM visit:
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Moderator: Lorri Zipperer 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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