Commonest error in medicine?

Jason Maude Jason.Maude at ISABELHEALTHCARE.COM
Fri Dec 5 21:47:04 UTC 2014


Darryl
I can see how it's useful to me as a consumer if Amazon gets to know my preferences but wouldn't that be a negative if Isabel did the same as it would then reduce its objectivity and create new biases?

Isabel does learn from clinicians' feedback through cases and new knowledge which is used to improve the system every 2 weeks. However, this is indirect rather than through algorithms doing it automatically.

Regards
Jason

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886<tel:+44%201428%20644886>
Tel: +1 703 879 1890<tel:+1%20703%20879%201890>
www.isabelhealthcare.com<http://www.isabelhealthcare.com>

_____________________________
From: darryl mackender <dmack2795 at gmail.com<mailto:dmack2795 at gmail.com>>
Sent: Friday, December 5, 2014 7:41 pm
Subject: Re: [IMPROVEDX] Commonest error in medicine?
To: Society to Improve Diagnosis in Medicine <improvedx at list.improvediagnosis.org<mailto:improvedx at list.improvediagnosis.org>>, Jason Maude <jason.maude at isabelhealthcare.com<mailto:jason.maude at isabelhealthcare.com>>


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<mailto: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:+44%201428%20644886>
Tel: +1 703 879 1890<tel:+1%20703%20879%201890>
www.isabelhealthcare.com<http://www.isabelhealthcare.com/>

From: Robert Bell < 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>>
Reply-To: Society to Improve Diagnosis in Medicine < IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Robert Bell < rmsbell200 at YAHOO.COM<mailto:rmsbell200 at YAHOO.COM>>
Date: Friday, 5 December 2014 03:55
To: " IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" < IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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<mailto:WSlater at PHCN.VIC.GOV.AU>>
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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]
Sent: Tuesday, 25 November 2014 11:41 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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.





________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.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<mailto: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<mailto:Lorri at ZPM1.com>, Communication co-chair, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
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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<mailto: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<http://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.





________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.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<javascript:_e(%7B%7D,'cvml','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 the IMPROVEDX:
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or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

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