disappointed

Jackson, Brian brian.jackson at ARUPLAB.COM
Thu Sep 24 14:32:24 UTC 2015


We might want to be careful about this one.  From a research perspective, analyzing time to diagnosis would indeed be interesting and productive.  But if in the process we give regulators, payors and attorneys new ways to punish delays at an individual physician level, it could amplify premature closure and overdiagnosis.

A suggestion others have brought up, and I suspect this needs to be pushed more aggressively, is the concept of explicitly labeling diagnoses with their level of certainty, e.g. as tentative or working diagnoses where appropriate.  Sometimes empiric therapy is the best way to proceed.  When empiric therapy fails, it doesn't necessarily mean the diagnostic process failed, i.e. that a diagnostic error occurred.

Many of the complications introduced by both medicolegal and quality improvement efforts come from treating diagnosis as a black and white situation.  As much as I like the current news coverage of the IOM report, it's reinforcing that black/white perspective.

--Brian Jackson

From: robert bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Sent: Wednesday, September 23, 2015 3:25 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] disappointed

But our foot is in the door.

Also, as we get more information on Time to Diagnosis, it would seem that there could be a kind of "standard time to diagnosis," for less common diseases/conditions that could be adjusted from time to time as we get more proficient (e.g. for myasthenia gravis), perhaps even adjusted in some way for the medical sophistication of the medical center in question!

Do we need to talk about standards for what is a delayed diagnosis?  Or maybe that has already been discussed.

Just publishing a list of the common conditions we THINK are diseases of delayed diagnosis would be a start.

Rob Bell, M.D.


On Sep 23, 2015, at 11:19 AM, Michael Grossman <Michael.Grossman at MIHS.ORG<mailto:Michael.Grossman at MIHS.ORG>> wrote:

I agree with your assessment. The IOM sometimes seems to fall short of expectations. Their relatively recent report on Graduate Medical Education was disappointing.
The fact that multiple news agencies are running with this story may lead to some misunderstandings , especially on the nature of "delayed diagnoses".
Michael Grossman, MD MACP

-----Original Message-----
From: Robert L Wears, MD, MS, PhD [mailto:wears at UFL.EDU]
Sent: Wednesday, September 23, 2015 9:31 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] disappointed

Great that misdiagnosis and related failures are getting attention, but ...

This is a disappointing effort; a naïve, keyhole view of a complex problem.

I count 82 mentions of 'error' in the first 15 pages (~5.5 per page), 753 in the entire document.

Lots of discussion about biases (78 mentions) but important issues that challenge the focus on 'error', such as hindsight bias, or outcome bias, are never mentioned even once.

This restriction to a very narrow framing of the problem is unlikely to lead to progress.

bob



Robert L Wears, MD, MS, PhD
University of Florida              Imperial College London
wears at ufl.edu<mailto:wears at ufl.edu>                        r.wears at imperial.ac.uk<mailto:r.wears at imperial.ac.uk>
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