Commonest error in medicine

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Mon Dec 8 15:24:29 UTC 2014


Dear Bob,
It is true that having the information from the patient to the doctor prior
to the office meeting is critical.  When the patient is encouraged to fill
out something like the Patient ToolKit, or to read on the doc's website
about his specialty or self-care, that alone tells the patient that the
doctor is interested in empowering the patient.  That may short-cut the
trust building, and certainly can focus the time together to the patient's
issues.

I would be gratified if the several doctors in my early care had read my
chart prior to entering the room, or had a better way to compare a series
of lab reports, and so on.  It distresses me that you find the environment
and tools in use to be an impediment to getting this type of info.  Assume
you are referring to some of the computer aids and the context of limited
visits.

Peggy

On Mon, Dec 8, 2014 at 7:06 AM, Swerlick, Robert A <rswerli at emory.edu>
wrote:

>  Each party requires inputs to accomplish what they want to accomplish.
> What the physician may think they need to accomplish may be very different
> from what the patient wants to accomplish. As Clayton Christensen has
> observed, we often err by trying to sell our customers a product they are
> not interested in buying.
>
>
>
> Much of the activity required to garner essential information can be off
> loaded to times outside of the face to face visit. I am looking for
> information from patients to be collected ahead of time so as I can really
> connect with patients and garner their trust when we actually meet. For
> physicians to be good diagnosticians there are essential data elements
> which we must have. Some confusion arises now because we may not realize
> what information we need to collect to make particular diagnoses. In order
> to ultimately figure out what information is important requires that we be
> very structured in terms of what we collect. Whether this makes our efforts
> appear more doctor-centric is an open question. In the long run being able
> to define what is important is very patient centric.
>
>
>
> I think my message is being able to free up time from the office visit by
> collecting and inputting information ahead of time is essential. It is not
> necessarily how we are taught to gather information that is the problem. It
> is the environment and tools we currently use which crowds out time to
> connect to patients.
>
>
>
> Bob Swerlick
>
>
>
> *From:* Peggy Zuckerman [mailto:peggyzuckerman at gmail.com]
> *Sent:* Monday, December 08, 2014 1:05 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
> *Subject:* Re: [IMPROVEDX] Commonest error in medicine
>
>
>
> Rob, Charlie, et al,
>
> I am not sure that you mean about trying this out, and wonder if you are
> thinking about a study or such. Surely there could be studies, years in the
> development and analysis, showing the value of this or not. During that
> time, patients will be interrupted by their doctors within 18-20 seconds,
> be unable to complete their story, and their diagnoses will be suboptimal.
>
> Some have rightly criticized the Toolkit for being too doctor-centric.
> The truth is that is was structured in recognition of the way that doctors
> are taught to gather patient information, assuming that it was easier to
> teach the patients this approach than change the physicians!  Sorry to my
> friends at the Society for Participatory Medicine for not taking a stronger
> stance on this, but I want improved diagnoses tomorrow morning, and we
> can't always wait for the doctors.
>
> The excellent advice to patients to gather one's thoughts, write out the
> questions, bring in the meds is excellent.  But having such a form ready to
> help with that task is helpful for the patient new to dealing with
> doctors.  We patients might actually try to take a few minutes to sound out
> the physician, thinking it is the polite and trust-building thing to do,
> while the doctor is stressed at the potential waste of time!
>
> Doctors could offer the Toolkit via their websites or even in the waiting
> room, and with that, start to build that trust relationship. Patients would
> learn to be more thoughtful about their own condition and their
> understanding of their symptoms, while a more organized and thorough
> history may emerge.
>
> I would love to get more comments from others, as in the great feedback
> above.  And I am getting the form re-created so patients can fill it  in
> online.  Let us patients help in this diagnostic process--we pay the
> greatest price when it goes wrong!
>
> Peggy Zuckerman
>
>
>
>
>
>
>
> On Sat, Dec 6, 2014 at 8:06 PM, Amy Reinert <amy.reinert at gmail.com> wrote:
>
> The recent research in "empathy failure" on the part of physicians is a
> good place to start if searching the literature for data that supports a
> need for a more humanistic approach to healthcare. It has only been in the
> last 3-4 years that this topic has received any attention at all, but it is
> picking up steam.
>
>
>
> For those looking to do something about the problem, a good place to start
> might be to encourage some cross pollination between humanistic psychology
> and medicine. Carl Roger's seminal work On Becoming a Person lays out the
> case for the necessity of mutual trust and respect in the clinical
> relationship. I firmly believe that Rogers' principles are as applicable to
> physicians as they are to psychologists. Unfortunately, in my
> observation, a great many MD's don't learn enough about psychology
> (humanistic in particular) to really know what they are dismissing before
> they refuse to entertain certain concepts within the physician-patient
> relationship. Too many think it is about "sensitivity training," which
> really is not the case. Unless something has been published very recently,
> as far as I know, there are no studies yet that demonstrate whether or not
> a more humanistic approach would be helpful in reducing errors. Perhaps
> this group could work with a medical school to do a long-term study on the
> effects of humanistic training on diagnostic accuracy.
>
>
>
> Amy Ruzicka, Ph.D.
>
>
>
> On Saturday, December 6, 2014, Robert Bell <
> 0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:
>
> Good points Vic.
>
>
>
> First, do we have good information that most errors come the way you
> suggest?
>
>
>
> If they do, do we need a code of practice interaction with patients,
> different but similar to what is being worked out with the police and
> public to de-escalate situations? Sounds like something the Speciality
> Societies could work on as with each branch of medicine the interactions
> would be different. But there could be a general code of patient contact
> put out by say the AMA to start the ball rolling if your thesis is correct.
>
>
>
> Is there any information in hospital Root Cause Analyses to suggest hat
> you are correct?
>
>
>
> If there was information, then getting it published would be a way to get
> things started.
>
>
>
> However, you bring to the front that generally we have no good data on
> anything related to errors. Also, the police do not have good nationwide
> data on how many unarmed people they kill each year.
>
>
>
> There is a great reluctance to make this information available on the part
> of the hospitals, physicians, and police because of litigation possibility.
>
>
>
> Then the question becomes do we first change the litigation laws.
>
>
>
> It is so complex - hard to know where to start.
>
>
>
> Rob Bell
>
>
>    ------------------------------
>
> *From:* Vic Nicholls <nichollsvi2 at gmail.com>
> *To:* Robert Bell <rmsbell200 at YAHOO.COM>
> *Sent:* Saturday, December 6, 2014 3:01 PM
> *Subject:* Re: [IMPROVEDX] Commonest error in medicine
>
>
>
> The most common errors in medicine are not listening to the patient and
> respecting that the patient might be telling you the truth, inability to
> believe a HCP can be wrong and to consider alternate diagnoses. Giving
> mental diagnoses because HCP's don't want to be bothered to do legwork.
>
> Last but most important is being human. I can think of a number of people
> harmed who would expect something other than bullying, gaslighting,
> stalking, gang stalking, risk managers/lawyers, and trying to use the cops
> to silence people. Not everyone is a lawsuit. Some people just want better
> & more compassionate care.
>
> I would add that being your own worst enemy ranks up there guys. If you
> can't consider the patient, consider why you got into medicine in the first
> place. When a doc says they see 60-70% talking about money, we're going to
> respond like that.
>
> Victoria
>
>
>
> On 12/6/2014 11:21 AM, Robert Bell wrote:
>
> Dear all,
>
>
>
> I had the idea that instead of talking and sharing thoughts on a list server that some of the good will, and the time of the contributors could be used to actually DO something useful. Be it a resolution sent to the organizers of the list on a particular issue, or the basis for an article/publication. This, and perhaps a little naively, considering that the most successful technology companies operate on the basis of creativity and inclusiveness being intertwined. And this list had an amazing cross section of talent and diversity. Somehow I had the idea that we could miraculously DO something to help with the apperent lack of progress in the last 15 years since the IOM report on Errors.
>
>
>
> But I think the hurdles of confidentiality, available tIme of contributors, differing society aims, competing projects, differing individual aims, patent considerations, litigation issues, and institute affiliations, etc., etc, are likely to make this all too great of an uphill battle.
>
>
>
> Thank you for all being so gracious, to at least try to move the idea forward.
>
>
>
> Robert Bell, M.D.
>
>
>
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> --
>
> Peggy Zuckerman
> www.peggyRCC.com
>
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-- 
Peggy Zuckerman
www.peggyRCC.com






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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