Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

Robert M Centor rcentor at UAB.EDU
Sun Jan 11 14:59:30 UTC 2015


Bob Latino asks an important question.  To rephrase – why cannot medicine be more like engineering?

Patients experience the same disease in many different ways.  They relate different symptoms and have different physical findings and laboratory tests.

The history gives us the greatest challenge.  Patients describe their symptoms in different ways.  Some patients deny their symptoms.  Some patients exaggerate their symptoms.  The great historian needs the art of reading between the lines.  We read body language.  We know when to seek additional information from family members or friends.

If we enter the proper data into our computer (either our biological computer or a program someone else has written) then we often (but not always) get to the correct diagnosis.

Additionally, while some patients follow Occam’s Razor, having a single cause for their symptoms, other follow Hickam’s Dictum (a patient can have as many diagnoses as he/she damn well please).  When patients have shortness of breath, we ask if the heart, lungs, muscles, etc are causing the symptoms.  Many patients have multiple diseases.  Are the new symptoms due to their known diseases or an additional new problem.

I therefore believe the diagnosis brilliance combines the science and the art.  The great diagnosticians spend much time using system 1 thinking and know when and how to proceed to system 2 thinking.  Knowing the textbook is not enough.  We need experience – thus the art.
==============

Robert M Centor, MD, MACP

Regional Dean, UAB Huntsville Regional Medical Campus
301 Governors Drive
Huntsville, AL 35801

Office: 256-539-7757
Fax: 256-551-4451

Chair, ACP Board of Regents

Professor, General Internal Medicine
UAB
FOT 720
1530 3rd Ave S
Birmingham, AL 35294-3407


From: Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>>
Date: Friday, January 9, 2015 at 1:51 PM
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] Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

I ask this as a non-clinician, "Should healthcare be more art than science?"

Understanding there are many unknowns in the field of medicine, as there are in science; but with regards to the 'knowns', shouldn't it be more science than art?

I come from the engineering disciplines (so from the left brain world), but with the 'knowns' there is a lot more structure and less variability in the application of the physical sciences in engineering.

With what is 'known' in medicine, why does there appear to be so much variability in 1) what is known (and who knows it) and 2) how it is effectively and consistently applied to the benefit of the patient.

Perhaps a naive question, but nonetheless on my mind as an layman observer:-)

Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com<mailto:blatino at reliability.com>
www.reliability.com

From: David Lawrance [mailto:david.lawrance at gmail.com]
Sent: Friday, January 09, 2015 2:37 PM
To: Society to Improve Diagnosis in Medicine; Bob Latino
Subject: Re: [IMPROVEDX] Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

And, thank goodness, most people seem willing to pay us, again.

At this point it is generally protocol to mention that healthcare is more art than science. I think that is another way of saying that artists are more accident-prone than are scientists.

David

On Wed, Jan 7, 2015 at 6:43 AM, Bob Latino <blatino at reliability.com<mailto:blatino at reliability.com>> wrote:
We never seem to have the time and budget to do things right, but we always seem to have the time and budget to do them again!

Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645<tel:1.800.457.0645>
blatino at reliability.com<mailto:blatino at reliability.com>
www.reliability.com<http://www.reliability.com>

From: Jason Maude [mailto:Jason.Maude at ISABELHEALTHCARE.COM<mailto:Jason.Maude at ISABELHEALTHCARE.COM>]
Sent: Wednesday, January 07, 2015 4:39 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

Thanks for alerting us to this article. One of the really positive things about the article is not just the improved care now being given but a great example of the Chief Medical Office and his senior colleagues managing/leading and setting a standard of care. He states in the article "I realize that many colleagues may see methods like ours as too intrusive on their clinical practice and may say that they don’t have the time.” I believe we need to see much more of this in hospitals. Too often, for example, we see DDS viewed as an end in itself rather than a tool to help with setting a standard of care and I think this explains why adoption of these tools is still relatively low.

Regards
Jason

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886<tel:%2B44%201428%20644886>
Tel: +1 703 879 1890<tel:%2B1%20703%20879%201890>
www.isabelhealthcare.com<http://www.isabelhealthcare.com/>

From: <Bruno>, Michael <mbruno at HMC.PSU.EDU<mailto:mbruno at HMC.PSU.EDU>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "Bruno, Michael" <mbruno at HMC.PSU.EDU<mailto:mbruno at HMC.PSU.EDU>>
Date: Tuesday, 6 January 2015 20:23
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

Greetings IMPROVEDX List-serve colleagues, and Happy New Year!

Thanks to Jason and Thomas for starting this years’ discussion.

The attached article appeared in the Sunday New York Times.   I thought it was relevant to our group’s discussion.

http://www.nytimes.com/2015/01/05/opinion/doctor-shut-up-and-listen.html?_r=0


All the best,

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Michael A. Bruno, M.D., F.A.C.R.
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Penn State College of Medicine
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From: Carroll, Thomas [mailto:Thomas_Carroll at URMC.ROCHESTER.EDU]
Sent: Tuesday, January 06, 2015 1:44 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] "Early diagnostic suggestions improve accuracy of GPs"

Interesting.  My question would be how this would translate to the real world.  In this artificial environment we know whether or not the “correct” dx is in the list of suggested dx’s.  That would not be the case in the real world.

Thomas M. Carroll M.D., Ph.D.
Assistant Professor, General Medicine & Palliative Care
University of Rochester
thomas_carroll at urmc.rochester.edu<mailto:thomas_carroll at urmc.rochester.edu>
Pager 5-1616 #3872
Tel: 585-275-7424<tel:585-275-7424> (General Medicine Office)
Tel: 585-273-1154<tel:585-273-1154> (Palliative Care Office)
Tel: 585-341-6775<tel:585-341-6775> (Resident Practice, Highland Hospital)

From: Jason Maude [mailto:Jason.Maude at ISABELHEALTHCARE.COM]
Sent: Tuesday, January 06, 2015 1:25 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] "Early diagnostic suggestions improve accuracy of GPs"

This is very interesting study just published in the British Journal of General Practice which also highlights the potential value of patients using symptom checkers and handing the results to their doctor at the start of the consultation. This would get over the current technical challenges of a system automatically producing a differential from more complex cases with multiple symptoms.

http://bjgp.org/content/65/630/e49<https://urldefense.proofpoint.com/v2/url?u=http-3A__bjgp.org_content_65_630_e49&d=AwMFAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=R16GG-MhGQFeEbiQbUUeP30HTmJHZlqL3XxjDPQtyXcSwB0zl0UIXhhofztdrEG1&m=eGvrWf26LmmmVkGW0vnRf9XeztEuR6JjBE8n1vgrIvU&s=uIrQIXl54eDZI6b32fN7ALZnLQKX_yTntnGzo_z3mD0&e=>

Regards and Happy New Year to the group.
Jason

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886<tel:%2B44%201428%20644886>
Tel: +1 703 879 1890<tel:%2B1%20703%20879%201890>
www.isabelhealthcare.com<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.isabelhealthcare.com_&d=AwMFAg&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=R16GG-MhGQFeEbiQbUUeP30HTmJHZlqL3XxjDPQtyXcSwB0zl0UIXhhofztdrEG1&m=eGvrWf26LmmmVkGW0vnRf9XeztEuR6JjBE8n1vgrIvU&s=rZEhyq7LgURp9ngavWrjRLodS2ccXYnsmuk6_HzmETc&e=>


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


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