Support Tests.

Stefanie Lee stefanieylee at GMAIL.COM
Tue Jan 26 02:08:16 UTC 2016


Part of the issue is framing (addressed in the recent IOM report) -
the view of the diagnostic specialties as provider of test results,
which are then used by the primary physician to diagnose the patient -
versus the pathologist or radiologist as being integrated into the
ongoing discussion and diagnostic process.

Communication is essential to safe patient care. As more than one
scenario can have the same imaging appearance, it is the clinical
information that allows the radiologist to form an educated opinion as
to what the significance of the finding is (and avoid the dreaded
'cannot exclude'!)

Rim-enhancing collection with gas bubbles in the surgical bed - an
abscess that needs to be drained, right? Not if Surgicel had been used
during the operation (a hemostatic agent that has a very similar
imaging appearance).

Given a CT or MRI which may have numerous abnormal findings in its
hundreds/thousands of images, the diagnostic process of putting all
the findings together to form an interpretation / hypothesis about
what is going on is not really all that different from other fields in
medicine.

Sometimes referring physicians are concerned about 'biasing' the
radiologist with clinical information, but providing less information
is unlikely to help improve accuracy - better communication will. If
anything in the report doesn't fit - pick up the phone or send an
email/fax for a second look!

As another example, consolidation on a chest radiograph is a
nonspecific finding that very frequently represents pneumonia and is
reported as such, but if this is a chronic process (especially if the
patient has weight loss without signs of infection), it could very
well be cancer.

Agree that providing patients access to test reports will help reduce
findings falling through the cracks. I read about patient portals on a
regular basis - how commonly are they used today?
http://meetinglibrary.asco.org/content/120470-140

Another area for improvement is to improve the ease/frequency with
which diagnostic specialists and office-based physicians communicate
with each other (e.g. direct phone lines).

Multidisciplinary rounds and discussions with referring physicians who
drop by the reading room are very helpful in clearing up diagnostic
conundrums - however, this mostly happens in the hospital setting.

(cannot tell from Dr. Elias' post if he conveyed his concerns about
the reports to the hospital or spoke with the radiologist directly - I
hope improving communication would be a goal of all involved in
patient care, for many obvious reasons)


On 24 January 2016 at 16:55, robert bell
<0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:
> I have suggested that at the same time, or even before we tackle Errors in
> Diagnosis, we see that all our support diagnostic tests (Lab, X-ray, etc.)
> are in good order so as to help make the correct diagnoses more often.






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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