Cognitive Autopsy in Emergency Medicine

robert bell rmsbell at ESEDONA.NET
Tue Oct 21 20:28:20 UTC 2014

The charming patient made me think of this.

I seem to remember in the blood pressure literature that well dressed executive looking women with brief cases have on average lower blood pressures recorded to the accurate blood pressure than than a poorly dressed less wealthy women.

I recall about 10 errors or more that could occur in the taking of a blood pressure. If they all cancel each other out that is good, but if they all add together you could be on antihypertensives for life when not needed.

I am thinking that a blood pressure measurement maybe one of the worst things we do in medicine.

There are lots of biases and errors in taking a Blood Pressure.

Rob Bell, M.D.

On Oct 21, 2014, at 11:06 AM, Ruth Ryan <rryan at LAMMICO.COM> wrote:

> The current issue of the Sullivan Group or TSG Newsletter aimed at emergency medicine carries an article about a case of missed diagnosis of Long QT Syndrome and does a cognitive autopsy. Click here
> Question about cognitive autopsies: why don’t we see “Denial” listed among the cognitive biases and errors in diagnosis? We see denial and sometimes paralysis in serious events (I can’t believe this charming patient could have a grave diagnosis; I’m not really seeing postpartum hemorrhage; my patient’s not having a post op complication from a bile duct I nicked; I can’t possibly be seeing the first case of Ebola diagnosed in the US, etc.)
> Ruth
> Ruth Ryan RN, BSN, MSW, CPHRM
> Senior Risk Management Education Specialist
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Robert M. Bell, M.D., Ph.C.
P.O. Box 3668
West Sedona, AZ  86340-3668
Tel: Fax: 928 203-4517

I am changing my e-mail address to rmsbell200 at  

Kindly change the e-sedona e-mail above in your address book so we stay in touch.

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