Another look at Questions

Michael.H.Kanter at KP.ORG Michael.H.Kanter at KP.ORG
Wed Jan 6 23:54:26 UTC 2016

interesting thoughts that you wrote below that are very thought provoking 
as usual.  Maybe I misunderstood but  you make the statement that " I felt 
that if there is a significant error rate in radiology reports and 
laboratory tests that this should be addressed first."
I personally consider error rates in radiology reports and lab tests 
within the scope of diagnostic errors and not sure why we would not 
address this quickly.   I do not believe that anywhere in the IOM report 
did they suggest otherwise.    In fact, radiology report errors really 
fall into the class of diagnostic errors related to visual errors and also 
occur in pathology reports and other areas of diagnosis where the 
diagnosis is made by visual interpretation of an image.  We recently 
published a method on how to decrease these for interpretation of retinal 
Visual errors that are based on stored images (as opposed to looking at a 
skin lesion of a patient) have some advantages in terms of study and 
performance improvement including
1) they are often stored in data systems for easy retrieval and 
2)  they can be retrospectively reviewed
3)  one can determine the incidence of diagnosing a disease if the image 
or image results are stored in a data system and use the variation in 
diagnosis as a measure of diagnostic error/variability as was done in the 
attached paper.
4)  Diagnosis based on visual images can be more easily studied because 
the variable of data acquisition can be controlled better (that is 
everyone can look at the same image/data) which is very different than a 
physical exam or patient history.

My point is that it may be simpler to study errors due to visual 
interpretation of images than other types of diagnostic errors and this is 
something to consider addressing sooner rather than later.

I really like the idea of specialists societies getting involved in 
diagnostic errors.    Specialists  are likely to see such errors in their 
practice when referals are sent too late or with the wrong diagnosis. 

Michael Kanter, M.D., CPPS
Regional Medical Director of Quality & Clinical Analysis
Southern California Permanente Medical Group
(626) 405-5722 (tie line 8+335)
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From:   robert bell 
<0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
Date:   01/02/2016 04:03 PM
Subject:        [IMPROVEDX] Another look at Questions

Dear All,

I would like to thank all the people on this list who kindly responded to 
my questions a few weeks back.

Since asking those questions I became aware that questions may be 

Does it follow then that statements are less creative. I then thought how 
does that come about? 

A question I thought, stimulates listeners and readers to think of various 
solutions. So from one question you might get many solutions. With 
statements you would be more relying on the creativity of the writer 
presenting his or her various ideas and solutions. And these all together 
may not be great in number. 

With regard to the medical profession as a whole and people in positions 
of power in the healthcare industry who can effect change, one can ask do 
they ask fewer questions for fear of being considered less knowledgeable? 
So, if this is true, almost by definition, if questions are creative, such 
decision makers are less likely to be broadly creative, at least 
initially? There are obvious exceptions. So a  question might be how to 
better take advantage of the crowd think? 

This all makes an assumption that most things in medicine are complex and 
that many solutions to an issue may be necessary to arrive at a good 

The IOM has issued its statement/report on diagnostic errors and there are 
some good suggestions. I was pleased to see teamwork mentioned first in 
their solution. Which essentially is an extension of crowd think.

But the big question is where do we go from here? As you all know I would 
have preferred standard medical errors to be approached first before 
diagnostic errors. For example, I felt that if there is a significant 
error rate in radiology reports and laboratory tests that this should be 
addressed first. But assuming that we may have the cart before the horse, 
and I am not completely sure about that, what questions could be asked of 
the established consortium of speciality societies?

Over and above the big structural solutions, what comes to mind for me is 
that some of these societies have issued Do and Don’t lists for their 

So my new question is, could those lists be looked at and the idea 
extended to all the specialty societies with the emphasis on reducing 
diagnostic error?

Also, with any statement(s) would it be good to consider asking some 
questions at the end to stimulate thought?

The best for 2016,

Robert M. Bell, M.D., Ph.C.


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