Ebola in Dallas

Shapiro, Barbara Barbara.Shapiro at UHHOSPITALS.ORG
Wed Oct 8 13:14:28 UTC 2014


Yes, I've heard this expression "work smarter" many times, but what does it really mean. There's no substitute for sitting with a patient and getting their history. For a neurologist, this can take a considerable amount of time. I work as fast and as 'smart' as I can, but there's no substitute for a good, thorough history, and a good thorough exam.  While I'm doing that, I'm trying to fulfill all of the "meaningful use" criteria on the electronic record, to keep the government happy, and be nice and cheerful and respectful of patients, and not rush them, so that when the Press Gainey survey comes out, I can make sure I'm at the top level, so the hospital doesn't penalize me for not being at the 100th percentile. Then I have to make sure to print out a summary of the encounterfor the patient before they leave my office. This all takes time. There's no getting around it, no 'smart' strategy that lessens the time to do all of these things, if you want to be a good clinician.  

Barbara E. Shapiro, M.D.,Ph.D.

Associate Professor of Neurology

UHCMC/CWRU

Neurological Institute

11100 Euclid Avenue

Cleveland, OH  44106-5098



(216) 844-7768  phone

(216) 983-0792  fax



Confidential Quality Assurance Peer Review Report Privileged Pursuant to O.R.C. Section 2305.24,2305.25,2305.251 and 2305.252

________________________________________
From: Hoffer, Edward P.,M.D. [EHOFFER at mgh.harvard.edu]
Sent: Wednesday, October 08, 2014 8:02 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG; Shapiro, Barbara
Subject: RE: [IMPROVEDX] Ebola in Dallas

Throw more money at the problem?  When we in the US already spend more than any other country in the world on medical care?  It ain’t gonna happen!
We need to work smarter and cut out the fat before we can expect to get resources to do what is really needed.

Edward P Hoffer MD
Massachusetts General Hospital/Harvard Medical School

From: Shapiro, Barbara [mailto:Barbara.Shapiro at UHHOSPITALS.ORG]
Sent: Wednesday, October 08, 2014 7:43 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Ebola in Dallas

You are correct. But so far society has shown us that nobody is willing to give us the resources we really need. It's cost benefit. What more needs to happen before society wakes up and we, as physicians, start getting the resources we need. I'm guessing the ER docs in Texas just didn't have the time to think through the situation - they certainly knew this was a febrile man who had just come from Liberia - my ten year old would have figured this out! But in the busy, crazy fog of the ER, they basically missed it.


Barbara E. Shapiro, M.D.,Ph.D.
University Hospitals Case Medical Center



From: David Meyers
Sent: 10/7/14, 8:18 PM
To: Society to Improve Diagnosis in Medicine
Subject: Re: [IMPROVEDX] Ebola in Dallas
In the end, some type of analysis of the facts will get at many of the contributing causes and corrections in the Dallas ebola case - knowledge deficits, failure to recognize the pattern, EHR issues, biases which always figure in decision-making, additional training, implementing protocols, etc.  But suppose a contributing factor IS the busy, harried, distracted ED staff who didn't have time to put all of the info together and make the right decision after thinking carefully about it, and instead acted as best they could under the circumstances - what Bob Wears has called the "tragedy of adaptability".  This is a recurring theme in a lot of diagnostic and other medical errors.  Are we, and more importantly the hospital CEO/CFOs and health insurers and maybe ultimately society prepared to make and pay for changes such as additional staff, more useful EHRs and other resources or the radical restructuring of clinical work which may be needed to fix these problems.  Perhaps the IOM will address this in their report on diagnostic error next year.

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