A little concern

Mark Gusack gusackm at COMCAST.NET
Sun Nov 29 06:23:38 UTC 2015

In answer to this very important question:


Most of what Dr. Bell has noted is, in large part, related to an increase in ‘Errors in Diagnosis’.  The more time it takes to complete an ancillary task the less time we physicians have to commit to the diagnostic process.  The more often an error is made operationally or technically during the diagnostic workup, the more confusion there is from the time we see the patient to the time we render a diagnosis.  The more difficult it is to read and comprehend a radiologic or pathology report the more likely a misinterpretation will occur.  And all of this feeds forward to increase our anxiety hampering our cognitive ability to render a correct diagnosis.


In my experience in clinical practice, in pathology practice, and as a risk management consultant, one has to deal with these system and operational level type problems as much as those directly related to cognitive errors like education, context, bias’, and so on.  I have had a number of opportunities to effect a large scale redesign in the laboratory field as well as in clinics and physician office practices.  With a well-designed, planned, and implemented redesign the environment created eliminated much of the three following adverse effects which I have noted affect the integrity of the diagnostic process:


ÆTIME PRESSURE: allowing the physician time to reflect upon the information at hand and check of the initial differential diagnosis against consultations or references

ÆCONFUSION: eliminating mistakes that occur due to the misinterpretation of diagnostic information or not knowing about available clinical data critical to a diagnosis

ÆANXIETY: which is known to reduce cognitive capabilities and so diagnostic acumen


The results I have been able to achieve have been very gratifying.  However, the time and resources necessary to achieve these results are considerable and require a great deal of clout which the individual physician often does not weld in today’s healthcare system.


I hope everyone has had a wonderful Thanksgiving.


Mark Gusack, M.D.


From: robert bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG] 
Sent: Saturday, November 28, 2015 8:49 PM
Subject: [IMPROVEDX] A little concern


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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