A little concern

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Sun Nov 29 03:16:27 UTC 2015

Dear Robert,
I must agree that the kinds of errors which you point out are indeed the
low-hanging fruit in catching not only errors of diagnosis, but also in
errors of treatment and in safety, and result in the creation of barriers
between patients and the caregivers, and undermine the relationship with
the health system.

As a patient advocate, i know that the essential reform of the health
system requires that the patient have his/her data upon its availability,
that doors open to information for the patient, and that those
administrative barriers that cause both disdain for and distrust of the
system, be demolishesd. All of this is in the interest of the patient,
whose interests should be the only ones which shape the delivery of
medicine.  Imagine the efficiency of the doctor and the patient being
notified of the poor PAP sample, getting the CD with the xrays in the hands
/portal of the patient, of the patient receiving his lab results and seeing
the abnormal findings.

In my own case, had I read the pathology report that says the ulcer for
which I was treated did not exist. My fellow kidney cancer patients report
frequently that the Xray done to check for some source of pain reveals a
kidney mass which is ignored by the doctor, as he looks only re the
suspected cracked rib. Bringing the patient into all these communications
is essential, and getting the patient involved this way will have an impact
on diagnoses.  This changes the conversation and certainly could trigger
that all important, 'What else could it be?" discussion.


Peggy Zuckerman

On Sat, Nov 28, 2015 at 5:49 PM, robert bell <
0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

> Dear all,
> On reflection I am wondering if we are on the right track in trying to
> deal with Errors in Diagnosis before all other errors?
> How can we ever hope to sort out diagnostic errors when there is so much
> error an confusion everywhere in medicine.
> - Just trying to get a CD sent from an X-ray Dept. to a specialist can be
> a nightmare. The private doctor’s office forgets to call the X-ray dept.
> The X-ray dept. is closed for the holidays and cannot get the CD away for
> three days.
> - Patient sees a new gynecologist, a PAP is undertaken and the results
> cannot be read by the pathologist because of a poor sample - but the
> doctor’s office forgets to call the patient to inform them. The patient
> never gets a PAP.
> - Lab work results are not called to the patient and a serious problem is
> forgotten/missed.
> - The doctor’s office does not have a calendar for next year, 2016. So the
> scheduled appointment is not made. The patient is asked to call the doctor
> in the new year and schedule an appointment. But forgets to do this.
> - Most Doctor’s private office do not have a person dedicated as Safety
> Officer to collect errors that occur in the practice and discuss and
> correct them, presumable because of litigation concerns - any meeting and
> error discussions possibly being discovered for court cases.
> - That accurate records of errors in medicine are not kept in hospitals
> presumably because of litigation concerns and hospital reputation. What use
> is it if you reduce errors in diagnosis in a hospital because of new
> systems introduced, but you cannot prove that what you are doing is
> effective because no on want to keep records.
> And on, and on, and on, and on………………………
> All of you can come up with simple things that go wrong that with common
> sense procedures could be rectified.
> So why not get the basic things first sorted out with procedural
> recommendations?
> Also, looking at the hindrances/barriers and working on those, even if it
> is litigation concerns, would be so valuable.
> Let’s work on the simple things first and start saving lives - and how
> would we prove that?
> Robert M. Bell, M.D., Ph.C.
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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