KevinMD post and Tedx about my sister's delay in diagnosis

Harold Bursztajn, MD hbursztajn at HMS.HARVARD.EDU
Tue Oct 13 15:33:58 UTC 2015


Creating a therapeutic alliance is a key to a valid history from a frightened patient.   And absent a valid history, diagnosis and the patient suffers.
Any potential gain in reliability of history via the use of checklists has to be weighed against the potential loss of validity.  Continuous education in diagnostic and therapeutic  interviewing can help to avoid dehumanization as the cost for documentation of f the record.
  

On October 13, 2015 11:10:27 AM EDT, "Ely, John" <john-ely at UIOWA.EDU> wrote:
>Mike,
>
> 
>
>You asked about outcome studies when checklists are used in primary
>care.  (see attached)
>
> 
>
>John
>
> 
>
> 
>
> 
>
>From: Ballas, Mike, M.D. [mailto:mballas at WILSONHEALTH.ORG] 
>Sent: Sunday, October 11, 2015 6:40 PM
>To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>Subject: Re: [IMPROVEDX] KevinMD post and Tedx about my sister's delay
>in diagnosis
>
> 
>
>Dr. Gunn,
>
> 
>
>Thank you for sharing your sister’s tragic story.   It moved me, and I
>commend you for your work in trying to improve outcomes for all
>patients.  In my 20 years of family practice I have been fortunate to
>not have “missed” an MI,  but your story magnifies the unrelenting 
>anxiety I still feel every time I see a chest pain patient.   Your
>story also intensifies my hope to find the best possible approach to
>chest pain and to other challenging symptoms (headaches, abdominal
>pain) that can have both simple self-limited etiologies as well as
>catastrophic etiologies, despite often presenting in very similar ways.
>
> 
>
>Are you aware of an algorithm in primary care that would have detected
>your sister’s CAD?  Would you look at the checklist that I’m using for
>chest pain patients? (see attachment).  Would this checklist have
>directed your sister towards a cardiac workup?  
>
> 
>
>Your sister’s case brings up another question ….are there any studies
>suggesting  that after a certain time period a patient should be
>referred or the highest likelihood ratio test should be ordered for an
>ominous complaint?   I have been told that if I see a patient 2-3 times
>for the same complaint then refer or get a better test,  but is there
>any evidence behind this?
>
> 
>
>If I could use your email to ask more questions on checklists…….I am
>trying to develop checklists based on evidence based medicine for
>common conditions and complaints (I would love to share them with
>anyone to get feedback).  Why doesn’t everyone use checklists in
>primary care? (I suspect time).  Is anyone aware of any outcome studies
>when checklists are used in primary care?  Dr. John Ely’s Oct. 8 email
>describing checklists in the airline industry appeared to promote the
>idea of checklists in medicine.  Is it time to modify the SOAP  note in
>medical practice and in medical education?  
>
> 
>
>I hope all your hard work will end up in a tool (history scoring
>system, lab test (anyone with any experience with CORUS CAD
>(cardiodx.com)?) or a better imaging test that I can use to prevent a
>catastrophic outcome like the one your family experienced.
>
> 
>
>Thanks,
>
> 
>
>Mike Ballas M.D.
>
> 
>
> 
>
> 
>
>From: Carol Gunn [mailto:office at OCCUPATIONALMEDICINEOREGON.COM] 
>Sent: Wednesday, October 07, 2015 1:25 PM
>To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>Subject: Re: [IMPROVEDX] KevinMD post and Tedx about my sister's delay
>in diagnosis
>
> 
>
>My view on this:
>
> 
>
>We need the subject to get to a tipping point.  Saw this with children
>and peanut allergies, police work and racial tensions, etc.  It is not
>there yet, but moving slowly closer. For me, it was not until I had a
>tragic experience, that I learned the statistics.  It all changed after
>I read Anna's 14,000 page medical record.  I'm on Sermo, the doctors'
>blog - not a lot of endorsement for the IOM reports. 
>
> 
>
>So I focused on a different route to share my mission. Hoping that
>similar to air bags in cars, when the public learns and then starts
>demanding a service/feature, we may get more traction. 
>
> 
>
>What also comes to mind is the hashtag, #PatientsLivesMatter.  
>
> 
>
>Carol 
>
> 
>
>-------- Original Message --------
>Subject: Re: [IMPROVEDX] KevinMD post and Tedx about my sister's delay
>in diagnosis
>From: robert bell <rmsbell200 at yahoo.com>
>Date: Wed, October 07, 2015 8:56 am
>To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG"
><IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>,
>office at OCCUPATIONALMEDICINEOREGON.COM
>
>Dear Carol, 
>
> 
>
>We don’t get far with guns mainly because of the gun lobby. 
>
> 
>
>Is there a healthcare “lobby,” overt or covert, that resists change as
>it pertains to patient safety? 
>
> 
>
>I do not know but have wondered why we do not make too much progress in
>patient safety as a whole (diagnostic and other errors).
>
> 
>
>Is it just the bottom line lobby?
>
> 
>
>Rob Bell, MD
>
>On Oct 7, 2015, at 7:34 AM, Carol Gunn
><office at OCCUPATIONALMEDICINEOREGON.COM> wrote:
>
> 
>
>SIDM,
>
> 
>
>It is my belief, despite the recent IOM report, that most Americans are
>still unaware of the diagnostic dilemmas in medicine and the number of
>medical errors.  In this community here - it is a hot topic.  Not so
>much with others, even healthcare providers.  I believe that change
>willoccur faster when the public /media starts pushing for changes.
>
> 
>
>I have elected to share my story via KevinMD and Tedx.
>
> 
>
>Please share both liberally...  they are linked below. My Tedx was
>given prior to the IOM report release.
>
> 
>
>https://www.youtube.com/watch?v=Lu-HcylvuU8
>
>http://www.kevinmd.com/blog/2015/10/its-time-for-health-care-to-stand-up-to-medical-errors-will-we.html
>
> 
>
>Thank you,
>
>Carol Gunn MD
>
> 
>
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>Robert M. Bell, M.D., Ph.C.
>
>P.O. Box 3668
>
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Harold J. Bursztajn, MD
Associate Clinical Professor of Psychiatry
Co-founder, Program in Psychiatry and the Law @
BIDMC Psychiatry of Harvard Medical School

President of the American Unit of the UNESCO Bioethics Chair

telephone 617-492-8366 
telefax 617-441-3195
email: hbursztajn at hms.harvard.edu
web http://www.forensic-psych.com

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


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