Clinical laboratory issues in diagnostic testing - recent Milwaukee Sentinel investigation

Ross Koppel rkoppel at SAS.UPENN.EDU
Sun Jul 12 19:04:22 UTC 2015


Well, the same is true if you take your car to the mechanic.
     When it comes to medicine,  I am not an MD and don't know what 
tests to most beneficially order or the range of diagnostic 
considerations that someone trained in medicine will/should/does 
consider.  I'm not a total idiot about cars or bodies, but I don't spend 
my life caring for either.  Even if you consider that 30% to 40% of the 
_very initial _Dx are wrong (goes down dramatically as stuff gets 
known), it's still probably better than my less informed hypotheses.   
Sure, I've guessed better sometimes than my doc.  Sure, he's been wrong 
or misdirected.  But he sees a lot more sick folk per hour than do I, 
and he knows more about the human body than do I.
     Should the doc listen to the patient?  Of course. Do they do that 
enough?  No.   But if I want to feel listened to, I talk with my dog, 
who is very patient, does not interrupt, and is not struggling with an 
EHR or an insurance rep seeking to deny coverage to everyone.  On the 
other hand, the dog's solution to all problems is to run and eat.  I do 
both; the first has been helpful, the latter far less so.


Ross Koppel, Ph.D. FACMI Sociology Dept and Sch. of Medicine Senior 
Fellow, LDI, Wharton University of Pennsylvania, Phila, PA 19104-6299 
215 576 8221 C: 215 518 0134
On 7/12/2015 2:01 PM, Peggy Zuckerman wrote:
> In my patient world, where I am alternately asked to be proactive 
> about my health and then to trust the doctor implicitly, not even 
> being guaranteed access to my own records, I see these errors as 
> deriving from the physician.  He determines which test I may need, he 
> sends me to get the labs, tells me not to call as only problems will 
> be relayed to me by a nurse/clerical worker, and makes his treatment 
> recommendations upon those results.
>
> If there is an error from the lab or in the reporting of those 
> results, or even in the choice of the test or the laboratory, from the 
> patient's point of view, it is the responsibility of the doctor.  Of 
> course, this is the same for imaging, the type thereof, the body parts 
> imagined, the results interpreted, etc.  This is not fair, but is the 
> reality.
>
> Peggy Zuckerman
>
>
> Peggy Zuckerman
> www.peggyRCC.com <http://www.peggyRCC.com>
>
> On Sun, Jul 12, 2015 at 7:59 AM, Robert Bell 
> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org 
> <mailto:0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
>
>     Does this make focussing on errors in medicine superfluous? Should
>     we not try to sort out the basics first?
>
>     Robert Bell
>
>
>
>
>
>     Sent from my iPad
>
>     On Jul 12, 2015, at 6:50 AM, David Meyers <dm0015 at COMCAST.NET
>     <mailto:dm0015 at COMCAST.NET>> wrote:
>
>>     http://www.jsonline.com/watchdog/watchdogreports/weak-oversight-allows-lab-failures-to-put-patients-at-risk-303445851.html
>>
>>     David L Meyers, MD FACEP
>>     Listserv Moderator
>>     Society to Improve Diagnosis in Medicine
>>
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