A little concern

Ross Koppel rkoppel at SAS.UPENN.EDU
Sun Nov 29 16:07:35 UTC 2015


As Peggy notes, many of the IT and bureaucratic failures you enumerate, 
Robert, have a recursive effect on diagnoses delays and errors.  I'm 
just emphasizing the loop and exacerbation of the errors to DX problems.
On the other hand, Peggy, I fear that the proportion of patients able to 
advocate for themselves (a la your great examples) is rather 
small....even with family/friend caregivers aiding them if they are so 
lucky.  Of course it's essential clinicians listen to patients, but 
given that so many patients are so sick and old etc, it's a pity that 
the system has so many holes that we must rely on patients for attentive 
care.

Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134

On 11/28/2015 10:16 PM, Peggy Zuckerman wrote:
> 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
>
> Peggy Zuckerman
> www.peggyRCC.com <http://www.peggyRCC.com>
>
> On Sat, Nov 28, 2015 at 5:49 PM, robert bell 
> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org 
> <mailto: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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