SIDM's priority: Translating ideas into action

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Thu Nov 5 18:08:35 UTC 2015


I believe the greatest obstacle to teaching critical diagnostic reasoning is we do not know how diagnosis is performed in actual practice and what the role of various concepts, for example, of probability is in it. In a recent paper posted on ListServ I argued that probability is not actually employed to any significant extent for diagnosis in actual practice and that a probabilistic approach may actually promote diagnostic errors. I think we need to examine carefully published examples of successful diagnosis such as in CPCs published in NEJM and learn what makes the diagnosis correct in practically every case in them. I am in the process of looking at 50 consecutive CPCs myself and am learning a lot of interesting things about how successful  diagnosis is performed. I hope to present my findings to you all in a few weeks' time.

Bimal

Bimal P Jain MD
Pulmonary-Criticalcare
Northshore Medical Center
Lynn MA 01904

From: Pat Croskerry [mailto:croskerry at EASTLINK.CA]
Sent: Wednesday, November 04, 2015 3:52 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] SIDM's priority: Translating ideas into action


Mark: these all look worthwhile initiatives.

I'd like to add a further one: given that a number of studies now point to a significant proportion of diagnostic failure being due to thinking failures, and given that meta-analytic studies demonstrate conclusively that by far the most effective way of improving reasoning and problem solving skills is through critical thinking interventions, I advocate for the introduction of critical thinking interventions at UGME and PGME. Others have already designated critical thinking as a meta-competency and some programs have embarked on this in separate initiatives. Others in the ethics domain have strongly proposed that this be done as an 'ethical imperative', and, given the unacceptably high estimates of preventable deaths from diagnostic failure it's hard to argue with that.

Rather than each inventing our own wheels, how about developing a generic Critical Thinking Module that would be available off the shelf that medical educators could use? The content could be approved by a consensus committee. This would be an inexpensive project with potentially high returns.

Pat


On 11/04/15 12:43 PM, Mark Graber <mark.graber at IMPROVEDIAGNOSIS.ORG> wrote:
With the IOM report now officially out on the street, SIDM is now focused on how to change practice to improve diagnosis.  The "Coalition to Improve Diagnosis" will be our first priority; the Coalition steering committee has had several meetings already, and the next steps are for each organization to identify at least one action they can take, and for all the members to agree on a common action. The Coalition will also be growing very soon to include another set of key national organizations.

We are also urging federal agencies to step up to the plate.  Founding Board member David Newman-Toker represented SIDM at a meeting yesterday of the AHRQ National Advisory Committee, and publicly thanked AHRQ for being a key supporter of our efforts through funding of our Diagnostic Error Conferences, the IOM report itself, and through the new R01 and R18 grant funding to study diagnostic error they have recently made available. We asked the NAC to support 3 initiatives deriving from the IOM report:  1) Developing a Common Format for organizations to report diagnostic errors to their Patient Safety Organizations; 2) Working with DOD, HHS, VA and others to develop the national research priorities for diagnosis, and to develop a public-private partnership to promote research; and 3) Providing dedicated funding for AHRQ to support research on diagnostic error in proportion to the harm associated with diagnostic error.

Later this month I'll be addressing a group at the CDC to emphasize the actions we'd like to see them take: 1) Resurrect the clinical pathologist position by providing funding for this type of consultation; 2) Resuscitate autopsies at key designated centers as a way to learn about errors; 3) Help develop and use failsafe procedures for test reporting; and 4) Use second opinions in anatomic pathology.

We'll provide updates on these activities as they come up, and would love to hear about initiatives that the listserv readership might also know about, or be involved with.

  Mark

Mark L Graber MD FACP
President, SIDM  www.improvediagnosis.org<http://www.improvediagnosis.org>
919 990-8497
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