Commonest error in medicine?

darryl mackender dmack2795 at GMAIL.COM
Fri Dec 5 19:42:25 UTC 2014


Jason
I think we met at the Chicago Diagnostic Error Conference
I am a General Physician with a research interest in Artificial
intelligence & have been exploring the analogies between web search
algorithms and other algorithms such as Amazon's recommendation algorithms
& other music suggestion algorithms all of which have in common a learning
feature of iteration - I.e others with similar inputs (book, music, website
preferences or choices) have used this algorithm & chosen X solutions. This
is what I think is missing from clinical decision support - a learning
iterative crowd( informed crowd) enhanced decision tree - is anyone you are
aware of working on this - I use Isabel every day but wish it could refine
its feedback the more I used it & the more others with similar diagnostic
challenges relevant to similar patients also used it

Darryl Mackender

On Friday, December 5, 2014, Jason Maude <Jason.Maude at isabelhealthcare.com>
wrote:

> I personally think that going down the route of trying to tackle the
> diagnoses which are most commonly missed is a mistake. As we have seen from
> the thread it means you end up with pathways and guidelines which people
> have to remember to use so you end up back at square one. If it is this
> complicated to cover the first say 30 most commonly missed diseases then
> when we will get to the rarer diseases? There seems to me an ethical
> problem in leaving those to so much later.
>
> The key point is *recognition of disease in time*. The issue is really
> the same whether it’s a cold or ebola. The only difference are the
> consequences of not recognising the disease in time. This is why I remain
> convinced that diagnostic decision support is a far more practical solution.
>
> DX support *reminds* the clinician of the *appropriate* diseases to
> consider based on the presenting clinical features whereas a body of work
> on commonly missed diseases would still rely on the clinician to remember
> it and appropriately synthesise it.
>
> The weak link of dx support is whether the clinician chooses to use it
> (although the latest integrations get around this by having the results
> automatically displayed as the clinician documents) while the weak link of
> new knowledge is whether it gets read, remembered and correctly processed.
>
> The best way is to make sure that useful knowledge about the commonly
> missed diagnoses is easily available when the dx support system has got the
> clinician thinking about it. Perhaps these diagnoses could be flagged as
> ‘easily missed’?
>
> Regards
> Jason
>
>
> Jason Maude
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886
> Tel: +1 703 879 1890
> www.isabelhealthcare.com
>
> From: Robert Bell <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
> <javascript:_e(%7B%7D,'cvml','0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG');>
> >
> Reply-To: Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG');>>,
> Robert Bell <rmsbell200 at YAHOO.COM
> <javascript:_e(%7B%7D,'cvml','rmsbell200 at YAHOO.COM');>>
> Date: Friday, 5 December 2014 03:55
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG');>" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG');>>
> Subject: Re: [IMPROVEDX] Commonest error in medicine?
>
> Good points Bill,
>
> No, not No. 1 misdiagnosis, but a fairly common missed diagnosis.  Not
> sure about over-diagnosis.
>
> I am sure PE work up tests are misinterpreted. Getting more clarity there
> may help with our efforts. Expert help would perhaps help here.
>
> Which before I forget it, what are the litigation issues with any
> monograph on common diagnostic errors in medicine?
>
> Rob
>
>   ------------------------------
>  *From:* "Slater, William" <WSlater at PHCN.VIC.GOV.AU
> <javascript:_e(%7B%7D,'cvml','WSlater at PHCN.VIC.GOV.AU');>>
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG');>
> *Sent:* Monday, November 24, 2014 8:31 PM
> *Subject:* Re: [IMPROVEDX] Commonest error in medicine?
>
> Ok, Robert. I like this.
>
> Are you suggesting that PE is no 1 miss-diagnosis or perhaps
> over-diagnosis?
> Or are CTPAs (with the radiation exposure) done far too often because the
> d-dimer test is misused or misinterpreted??
>
> In my view we may be over-diagnosing and therefore over-treating small,
> clinically insignificant PEs.
>
>
> Bill Slater FRACP
>
> Director Physician Education Peninsula Health Melbourne
>
> *From:* robert bell [mailto:rmsbell at ESEDONA.NET
> <javascript:_e(%7B%7D,'cvml','rmsbell at ESEDONA.NET');>]
> *Sent:* Tuesday, 25 November 2014 11:41 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG');>
> *Subject:* [IMPROVEDX] Commonest error in medicine?
>
> A thought.
>
> Do we know what is the most common serious error in diagnosis in medicine
> in the USA?
>
> If not can we guess at what is the commonest error in diagnosis? And then
> perhaps the top five.
>
> Then could we discuss intensely on line and come to conclusions as to how
> we could lower that rate?
>
> When we have come up with a list of suggestions for that one error we move
> on to Number 2  on what we think is the list of commonest serious errors in
> Medicine and how to reduce their incidence.
>
> This way we would be doing something positive rather than just talking.
> Not that talking is important.
>
> My contribution for serious No. 1 is Pulmonary embolism.
>
> This way we could just on line make a seripous contribution to medicine
> particularly if someone would write up our discussions.
>
> A thought
>
>
> Robert M. Bell, M.D., Ph.C.
>
>
>
>
>
> ------------------------------
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