Support Tests.

Robert Bell rmsbell200 at YAHOO.COM
Tue Jan 26 15:33:06 UTC 2016

One of the important things about communication is that people in positions of authority (e.g. HCPs) do not like asking questions. Most medical students at medical school do not ask questions very often. 

Questions apart from obtaining valuable information are also creative. Questions should be part of critical thinking. Unfortunately the downside is that questions and their answers take time.

How can, with such strong resistence, we bridge this gap and Follow the IOM recommendations?

Can the airline, or the nuclear industry help us?

Rob Bell, MD

Sent from my iPad

On Jan 25, 2016, at 7:08 PM, Stefanie Lee <stefanieylee at> wrote:

> 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?
> 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> 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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