Role of diagnosis in cutting waste in clinical care

Robert Bell rmsbell at ESEDONA.NET
Fri Nov 7 16:36:37 UTC 2014


Good points Ehud.

The answer I think is in education and repeated testing. I am also not sure we can ignore a generation of physicians and wait for the newly trained doctors to reduce overall diagnostic errors. Just do the math on that and calculate the deaths, and suffering that delay would bring.

In the scheme of things errors are a problem ten thousand times worse than the recent Ebola outbreak.

This needs activism galore and radiical changes in data collection, education and testing. This in turn needs leadership. Just the computer availability of sympton lists and possible diagnoses with their guessed frequencies would helpful tomorrow.

Moving towards simulator training using computers for physicians and eventually for all healthcare professionals would seem to be the way to go. I would expect that pysicians trained in current educational methods could be retrained to simulator like based prcesses. 

I do not have a complete picture in my mind of how this could all work but I suspect that those in the research field have a far better idea. 

Getting everyone on Board for such a massive change would be immense and perhaps even impossible. Could one or two of the specialty societies lead the way, perhaps working in collaboration with private enterprise? Could it be rolled into the affordable care act in time to help acceptance?

With computer help I beleive nearly ever bright person can do a good job in medicine. Airline pilots as a whole with their simulator training mostly seem to do a good job. The training  reduces the variation in peformance.

In medicine recertification exams could slowly be introduced with the new computer/simulator approaches so we do not banish past trained physicians to higher diagnostic error rates.

Great post Ehud. We really need discussion on what is likely to move this whole field forward a lot faster than now. 

Bravo!

Robert Bell, M.D.





Sent from my iPad

On Nov 7, 2014, at 4:33 AM, Ehud Zamir <ezamir at UNIMELB.EDU.AU> wrote:

> "The key question is how do you (practically) make our current clinicians "skilled diagnosticians" (those that aren't already of course)?"
> 
> I will try to suggest a practical answer: I am not sure you can make our current clinicians "skilled diagnosticians". However, you can invest in your next generation of diagnosticians. The elephant in this room, in my view, is that not everyone CAN be a skilled diagnostician, just like not everyone can be a competent surgeon or an airline pilot. It seems to me that we regard the issue of insufficient diagnostic ability as a taboo and hardly mention it.  We will only be able to improve if we are willing to acknowledge that not everyone who has high enough high school marks to get into medical school at 18 has the capacity to eventually become a good diagnostician at twice that age. 
> 
> So there should be three parts to this: increased emphasis on diagnostics during training, better assessments, looking at realistic, authentic diagnostic performance as opposed to contrived exam performance, and finally openness to the idea that not everyone who starts medical school should eventually be allowed to practice as a specialist/ independent medical practitioner. I suspect investing in education and more rigorous assessments during speciality training will be far more beneficial and practical than  re training doctors who despite many years of experience lack expertise. If we start doing it now, then in 20 years the mix of diagnostic skills will probably be significantly more favourable than it is now. I think Jerome Groopman put it much more eloquently in his book "How Doctors Think".
> 
> There is, of course, a political problem here, as those who make decisions about education first need to acknowledge that the current system of medical education and assessment is not optimal. Given that medical education is increasingly being hijacked by "educationalists" who often are non medical education academics with little or no medical knowledge, I doubt they will drive such a change or agree to it. Similarly, medical associations will likely object to a "we deserve better doctors" move.       
> 
> Ehud 
> 
> 
> Ehud Zamir, MD, FRANZCO
> 
> Clinical Senior Lecturer
> The University of Melbourne
> Centre for Eye Research Australia
> The Royal Victorian Eye and Ear Hospital
> 32 Gisborne Street
> East Melbourne, Victoria 3002
> 61-3-9929-8176
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> From: Jason Maude [Jason.Maude at ISABELHEALTHCARE.COM]
> Sent: Friday, 7 November 2014 4:21 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: [IMPROVEDX] Role of diagnosis in cutting waste in clinical care
> 
> You may all be interested to see a paper just published by the Academy of Medical Royal Colleges in the UK entitled "Protecting resources, promoting value:
> a doctor’s guide to cutting waste in clinical care" 
> 
> http://www.aomrc.org.uk/doc_download/9793-protecting-resources-promoting-value.html
> 
> My favourite part is on P20 where it states so perfectly:
> 
> "Fundamental attributes of a value-promoting doctor
> 
> A skilled diagnostician:
> forms intelligent differential diagnoses and can discern which investigations are truly necessary to diagnose and treat the patient effectively."
> 
> The key question is how do you (practically) make our current clinicians "skilled diagnosticians" (those that aren't already of course)?
> 
> Regards
> Jason
> 
> Jason Maude
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886
> Tel: +1 703 879 1890
> www.isabelhealthcare.com
> 
> 
> 
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> 
> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> 
> 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/
> 
> 
> 
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> 
> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> 
> 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/








HTML Version:
URL: <../attachments/20141107/da3d4f3b/attachment.html>


More information about the Test mailing list