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

Robert L Wears, MD, MS, PhD wears at UFL.EDU
Tue Jan 13 01:26:23 UTC 2015


agree this is not a question that's amenable to experimentation

but there is some suggestive evidence in Phillip Resnik's work -- he compared narrative 
notes and bulletized notes (such as produced by an EMR) and found the latter led to 
significantly more serious omissions, particularly of information clinicians thought was 
important (eg, a pt being unable to get on an exam table) but that was not amenable to 
structured data collection.  

Resnik,P., Niv, M., Nossal, M., Kapit, A., & Toren, R. (2008). Communication of clinically relevant 
    information in electronic health records:  a comparison between structured data and 
    unrestricted physician language. Paper presented at the Computer Assisted Coding 2008.

I think some of the differences in opinion here arise because we're likely talking about 2 different 
problems.  Closed loop control is great for managing known problems in known circumstances.  But 
when the problem is not a given, then sense-making -- characterizing problems by constructing them 
from a stream of phenomena that are puzzling, troubling, uncertain is quite a different task 

bob

On 12 Jan 2015 at 19:08, Alan Morris wrote:

Date sent:	Mon, 12 Jan 2015 19:08:03 +0000
Send reply to:	Society to Improve Diagnosis in Medicine
             	<IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>,
       	Alan Morris <Alan.Morris at IMAIL.ORG>
From:	Alan Morris <Alan.Morris at IMAIL.ORG>
Subject:	Re: [IMPROVEDX] Recent article From the Sunday New York Times: "Doctor, shut up and listen!"
To:	IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

> Yes, Dr. Centor.  That is an important comment.  My colleagues and I
> have data and published experimental results.  Lou Sheppherd published
> data.  Paul Meehl published data.  What I sense here is a conflict
> between strongly held opinions (absent data) and experimental results.
>  Would it not be worthwhile to at least explore the data, rather than
> allowing  strong opinions to prevail? Alan H. Morris, M.D.
> 
> From: Robert M Centor <rcentor at uab.edu<mailto:rcentor at uab.edu>>
> Date: Monday, January 12, 2015 at 11:24 AM
> To: Society to Improve Diagnosis in Medicine
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>>, Alan Morris
> <alan.morris at imail.org<mailto:alan.morris at imail.org>> Subject: Re:
> [IMPROVEDX] Recent article From the Sunday New York Times: "Doctor,
> shut up and listen!"
> 
> Data and experimental results would be almost impossible to collect.
> 
> Patients experience discomfort in different ways - because humans are
> complex biological organisms.  Two patients can give very similar
> histories and have different underlying disease.  Two patients can
> have the same disease and yet provide very different histories. 
> Sometimes experienced observers obviate the need for "experimental
> results" -- Robert M Centor, MD, MACP
> 
> Chair ACP Board of Regents
> Regional Dean, UAB Huntsville Regional Medical Campus
> 301 Governors Drive
> Huntsville, AL 35801
> 
> Office: 256-539-7757
> Fax: 256-551-4451
> 
> Professor, General Internal Medicine
> UAB
> FOT 720
> 1530 3rd Ave S
> Birmingham, AL 35294-3407
> Office: 205-934-3007
> 
> From: Alan Morris
> <Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>> Reply-To:
> Society to Improve Diagnosis in Medicine
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>>, Alan Morris
> <Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>> Date: Monday,
> January 12, 2015 at 11:02 AM To:
> "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>"
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>> Subject: Re: [IMPROVEDX] Recent article From the Sunday
> New York Times: "Doctor, shut up and listen!"
> 
> We all have opinions, of course.  Do any have data/experimental
> results to offer in this discussion? Alan
> 
> From: Albert Wu <awu at JHU.EDU<mailto:awu at JHU.EDU>>
> Reply-To: Society to Improve Diagnosis in Medicine
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>>, Albert Wu <awu at JHU.EDU<mailto:awu at JHU.EDU>> Date: Monday,
> January 12, 2015 at 9:37 AM To:
> "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>"
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>> Subject: Re: [IMPROVEDX] Recent article From the Sunday
> New York Times: "Doctor, shut up and listen!"
> 
> A long as we are piling on, I´m in Bob´s camp
> 
> If algorithms are going to work they still need to be delivered by
> Lisa Rosenbaums (great piece!)
> 
> Best regardsAlbert
> 
> Albert W. Wu, MD, MPH, FACP
> Professor and Director
> Center for Health Services & Outcomes Research
> Johns Hopkins Bloomberg School of Public Health
> 624 N Broadway Room 653
> Baltimore MD 21205
> (410) 955-6567 / fax (410) 955-0470
> Mobile (410) 978-1539
> 
> 
> From: <Thomas>, Eric Thomas
> <Eric.Thomas at uth.tmc.edu<mailto:Eric.Thomas at uth.tmc.edu>> Reply-To:
> Society to Improve Diagnosis in Medicine
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>>, Eric Thomas
> <Eric.Thomas at uth.tmc.edu<mailto:Eric.Thomas at uth.tmc.edu>> Date:
> Monday, January 12, 2015 at 11:26 AM To:
> "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>"
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>> Subject: Re: [IMPROVEDX] Recent article From the Sunday
> New York Times: "Doctor, shut up and listen!"
> 
> As long as we are taking sides :) , I´ll also side with Bob and Ed. 
> Ed´s bridge analogy is good.  With patients you almost never have a
> clear view of all the facts.  This is especially true in primary care,
> less so in some subspecialties.  So although medicine can benefit from
> more standardization I am skeptical that history taking can be
> rule-based.  Partly rule-based yes, but ultimately there is a degree
> of subjectivity, complexity, misinformation, misunderstanding, and
> "art" that occurs between a doctor and patient that defies logic.
> 
> I never cease to be amazed by the way patients describe how they feel,
> how they are selective about information they provide me, how they
> understand what is wrong and why....the list goes on and on.  I rarely
> have all the "facts" and a rule-based tool to collect the facts would
> only take me a few steps in to this maze.  And by the way, I don´t
> find this maze frustrating, I find it endlessly rewarding to try and
> understand my patients and to help them.
> 
> I think Lisa Rosenbaum´s recent essay in the New England Journal helps
> illustrate part of this complex nature of patient-doctor communication
> by providing a rich and fascinating glimpse into patient beliefs about
> taking medicines for heart disease:
> http://www.nejm.org/doi/full/10.1056/NEJMms1409015?query=featured_home
> 
> Best,
> 
> Eric
> 
> Eric J Thomas MD, MPH
> Professor of Medicine
> Associate Dean for Healthcare Quality
> Director, UT Houston-Memorial Hermann Center for Healthcare Quality
> and Safety The University of Texas Medical School at Houston 6410
> Fannin UPB 1100.44 Houston, TX 77030 713-500-7958
> www.utpatientsafety.org<http://www.utpatientsafety.org/>
> https://twitter.com/EJThomas_safety
> 
> 
> 
> 
> 
> 
> 
> From: Hoffer, Edward P.,M.D. [mailto:EHOFFER at MGH.HARVARD.EDU]
> Sent: Monday, January 12, 2015 6:03 AM
> To:
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGN
> OSIS.ORG> Subject: Re: [IMPROVEDX] Recent article From the Sunday New
> York Times: "Doctor, shut up and listen!"
> 
> Indeed, as an MIT grad who planned to be an engineer, I must side with
> Dr. Centor.  If you are tasked to build a bridge, virtually all of the
> parameters are defined. The bridge will go from A to B [unless perhaps
> it is in Alaska  :)], it will carry vehicles of up to X tons with a
> fudge factor for truckers who disobey posted limits; the average and
> maximum recorded wind velocity are known, etc.
> 
> When faced with a patient with an undefined illness, you must strike a
> balance between letting them tell their story and guiding the history
> when they are clearly going off on irrelevant tangents; you must have
> or establish enough rapport that they will tell you things that might
> be embarrassing or uncomfortable; you must know enough to ask about
> things that have not brought up that are suggested by what they have;
> you must be able to interpret what they tell you about past medical
> encounters and tests.  MUCH harder.
> 
> Ed
> 
> Edward P Hoffer MD, FACC, FACP
> Associate Clinical Professor of Medicine, Harvard
> 
> From: Swerlick, Robert A [mailto:rswerli at EMORY.EDU]
> Sent: Sunday, January 11, 2015 7:59 PM
> To:
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGN
> OSIS.ORG> Subject: Re: [IMPROVEDX] Recent article From the Sunday New
> York Times: "Doctor, shut up and listen!"
> 
> A test to show whether you are correct?
> 
> Robert A. Swerlick, MD
> Alicia Leizman Stonecipher Chair of Dermatology
> Professor and Chairman, Department of Dermatology
> Emory University School of Medicine
> 404-727-3669
> ________________________________
> From: Robert M Centor [rcentor at UAB.EDU<mailto:rcentor at UAB.EDU>]
> Sent: Sunday, January 11, 2015 4:47 PM
> To:
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGN
> OSIS.ORG> Subject: Re: [IMPROVEDX] Recent article From the Sunday New
> York Times: "Doctor, shut up and listen!" I must disagree.  The art is
> in the data collection.  Taking a history is much more complex than
> asking a list of questions.  Each question has many branch points
> depending upon how one interprets the words, the body language, and
> the patient´s context.
> 
> I do believe that this process requires artistry.  What am I missing?
> ==============
> 
> 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: Alan Morris
> <Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>> Reply-To:
> Society to Improve Diagnosis in Medicine
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>>, Alan Morris
> <Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>> Date: Sunday,
> January 11, 2015 at 10:44 AM To:
> "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>"
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>> Subject: Re: [IMPROVEDX] Recent article From the Sunday
> New York Times: "Doctor, shut up and listen!"
> 
> Beo Centor makes the argument that medical diagnosis is "science" plus
> "art," and cannot be more like engineering  Science and art are two
> broad terms that can have multiple meanings, the specific definitions
> of which determine subsequent argument.  The science of medicine at
> the patient-clinician encounter is flimsy.  Replicable methods are
> rarely pursued.  The art of medicine is sometimes uses as a
> wastebasket for the remarkable achievements of accomplished clinicians
> (e.g., William Osler) while ignoring his admonition that method is
> required for all but geniuses.
> 
> I believe Dr. Centor has confounded two constructs that are frequently
> not adequately identified and separated:
> 
>   1.  System of interest:   Sick patients are more complex than
>   mechanical or electrical systems.  A patient, for example, is much
>   more complex than an airplane.  This leads many to conclude that
>   engineering solutions, like those in airplanes, cannot be done in
>   medicine.  However, the human decision-maker (and his/her cognitive
>   limitations) is common to both systems. 2.  Human decision-maker
>   cognitive limits (4±1 constructs in short-term memory before
>   decisions become degraded):  The clinician decision-maker and the
>   pilot decision-maker are both cognitively limited by the same amount
>   - and they are both overloaded by information.  Pilots can enjoy the
>   benefit of autopilot programs, because the engineers have invested
>   the effort to understand the control needs of airplanes.  We can
>   clearly do the same for clinician decision-makers - feasibility is
>   well-established - but the medical community is so married to the
>   "cottage industry" model of the independent clinician decision-maker
>   that we have not invested the effort to establish and scale
>   autopilots for clinicians.
> Healthcare challenges require a combination of autopilot and
> independent clinician decision-maker (cottage industry).  We seem to
> be making precious little progress with this combination.  I know of
> no systematic effort to pursue scaling of autopilot programs in
> medicine.  This may, in part, be what led Eric Topol, MD to claim that
> medicine is so conservative, its thinking is ossified.
> 
> Alan
> Alan H. Morris, M.D.
> Professor of Medicine
> Adjunct Prof. of Medical Informatics
> University of Utah
> 
> Director of Research
> Pulmonary/Critical Care Division
> Sorenson Heart & Lung Center - 6th Floor
> Intermountain Medical Center
> 5121 South Cottonwood Street
> Murray, Utah  84157-7000, USA
> 
> Office Phone: 801-507-4603
> Mobile Phone: 801-718-1283
> 
> From: Robert M Centor <rcentor at UAB.EDU<mailto:rcentor at UAB.EDU>>
> Reply-To: Society to Improve Diagnosis in Medicine
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>>, Robert M Centor <rcentor at UAB.EDU<mailto:rcentor at UAB.EDU>>
> Date: Sunday, January 11, 2015 at 7:59 AM To:
> "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>"
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.ORG>> Subject: Re: [IMPROVEDX] Recent article From the Sunday
> New York Times: "Doctor, shut up and listen!"
> 
> 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.IMPROVEDIAG
> NOSIS.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.IMPROVEDIAG
> NOSIS.ORG>"
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.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<https://urldefense.proofpoint.com/v2/url?u=http-3A
> __www.reliability.com&d=AwMFAw&c=6vgNTiRn9_pqCD9hKx9JgXN1VapJQ8JVoF8oW
> H1AgfQ&r=mY6wClgg9bB7_KFlGTqqsxa1oasn-a2wOpcZWTLBmj0&m=qffqJNXbGk1Y22G
> Ct9UyBm2n32bIF4mnkdSNOw4yDnw&s=DXLacY0AzLQC9QIBcXYKUCxiHDXjqLlf_E7VbQz
> I8sU&e=>
> 
> 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<https://urldefense.proofpoint.com/v2/url?u=http-3A
> __www.reliability.com&d=AwMFAw&c=6vgNTiRn9_pqCD9hKx9JgXN1VapJQ8JVoF8oW
> H1AgfQ&r=mY6wClgg9bB7_KFlGTqqsxa1oasn-a2wOpcZWTLBmj0&m=qffqJNXbGk1Y22G
> Ct9UyBm2n32bIF4mnkdSNOw4yDnw&s=DXLacY0AzLQC9QIBcXYKUCxiHDXjqLlf_E7VbQz
> I8sU&e=>
> 
> From: Jason Maude
> [mailto:Jason.Maude at ISABELHEALTHCARE.COM<mailto:Jason.Maude at ISABELHEAL
> THCARE.COM>] Sent: Wednesday, January 07, 2015 4:39 AM To:
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGN
> OSIS.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<https://urldefense.proofpoint.com/v2/url?u=ht
> tp-3A__www.isabelhealthcare.com_&d=AwMFAw&c=6vgNTiRn9_pqCD9hKx9JgXN1Va
> pJQ8JVoF8oWH1AgfQ&r=mY6wClgg9bB7_KFlGTqqsxa1oasn-a2wOpcZWTLBmj0&m=qffq
> JNXbGk1Y22GCt9UyBm2n32bIF4mnkdSNOw4yDnw&s=tmxUA8BuP9Z9n9MUk8j2fGTa3Ama
> qNSxJOuyDvfX3Ps&e=>
> 
> 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.IMPROVEDIAG
> NOSIS.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.IMPROVEDIAG
> NOSIS.ORG>"
> <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAG
> NOSIS.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.ht
> ml?_r=0<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.nytime
> s.com_2015_01_05_opinion_doctor-2Dshut-2Dup-2Dand-2Dlisten.html-3F-5Fr
> -3D0&d=AwMFAw&c=6vgNTiRn9_pqCD9hKx9JgXN1VapJQ8JVoF8oWH1AgfQ&r=mY6wClgg
> 9bB7_KFlGTqqsxa1oasn-a2wOpcZWTLBmj0&m=qffqJNXbGk1Y22GCt9UyBm2n32bIF4mn
> kdSNOw4yDnw&s=2uw5_WOXY2z3jGuLeqU94nbxI5Ghil9R6C2EkpAv5t8&e=>
> 
> 
> All the best,
> 
> [Description: Description: Description:
> \\hersheymed.net\files\Staff\M\mbruno\Signature2.gif.gif] Michael A.
> Bruno, M.D., F.A.C.R. Professor of Radiology & Medicine Director of
> Quality Services & Patient Safety The Milton S. Hershey Medical Center
> Penn State College of Medicine 500 University Drive, Mail Code H-066
> Hershey, PA  17033
> 
> Phone: (717) 531-8703<tel:%28717%29%20531-8703>
> Fax:      (717) 531-5596<tel:%28717%29%20531-5596>
> 
> e-mail: mbruno at hmc.psu.edu<mailto:mbruno at hmc.psu.edu>
> 
> [cid:image002.png at 01CF4E6D.0D6442B0]
> 
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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.IMPROVEDIAGN
> OSIS.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.IMPROVEDIAGN
> OSIS.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/v
> 2/url?u=http-3A__bjgp.org_content_65_630_e49&d=AwMFAg&c=4sF48jRmVAe_CH
> -k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=R16GG-MhGQFeEbiQbUUeP30HTmJHZlqL3XxjDP
> QtyXcSwB0zl0UIXhhofztdrEG1&m=eGvrWf26LmmmVkGW0vnRf9XeztEuR6JjBE8n1vgrI
> vU&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>
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> 
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis
> in Medicine
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Robert L Wears, MD, MS, PhD
University of Florida  	Imperial College London
wears at ufl.edu       	r.wears at imperial.ac.uk
1-904-244-4405 (ass't) 	+44 (0)791 015 2219
Many a fine tune's been played on an old fiddle.






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


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