Support Tests.

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Tue Jan 26 18:45:57 UTC 2016


One step further is to provide the reports directly to the patients, both
in recognition of their right to have those reports, ande that the doctor
and patient both are aware of all the findings in the report.  Of course,
the patient can also be told that there will be extra findings besides
those for which the test was done. In my kidney cancer world where 30-40%
of tumors are found 'incidentally', stories abound of the tumor being noted
by the radiologist, and overlooked by the physician worrying more about
rib.

Peggy

Peggy Zuckerman
www.peggyRCC.com

On Tue, Jan 26, 2016 at 10:41 AM, Peggy Zuckerman <peggyzuckerman at gmail.com>
wrote:

> To Edward;  Not only why would they want to look at films, but also why
> would they want to look at patients?
>
> Peggy Zuckerman
> www.peggyRCC.com
>
> On Tue, Jan 26, 2016 at 9:33 AM, Hoffer, Edward P.,M.D. <
> EHOFFER at mgh.harvard.edu> wrote:
>
>> Because house staff spend all their time massaging the EMR. Since they
>> have been documented to be spending over three times as long at the
>> terminal as at the bedside, why would they want to look at films?
>> ------------------------------
>> *From:* Bob Latino [blatino at RELIABILITY.COM]
>> *Sent:* Tuesday, January 26, 2016 11:54 AM
>>
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] Support Tests.
>>
>> If this practice was so effective in the 70's and 80's, why did it fade
>> away?
>>
>>
>>
>> Why aren't such proven best practices maintained and sustained?
>>
>>
>>
>> *Robert J. Latino, CEO*
>>
>> Reliability Center, Inc.
>>
>> 1.800.457.0645
>>
>> blatino at reliability.com
>>
>> www.reliability.com
>>
>>
>>
>> *From:* Albert Wu [mailto:awu at JHU.EDU]
>> *Sent:* Tuesday, January 26, 2016 11:05 AM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] Support Tests.
>>
>>
>>
>> I recall doing precisely this while a med student and resident at New
>> York Hospital, and Mt Sinai in NYC in the mid 80s
>>
>>
>>
>> albert
>>
>>
>>
>> *From: *Alan Morris <Alan.Morris at IMAIL.ORG>
>> *Reply-To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Alan Morris <Alan.Morris at IMAIL.ORG>
>> *Date: *Tuesday, January 26, 2016 at 10:19 AM
>> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> *Subject: *Re: [IMPROVEDX] Support Tests.
>>
>>
>>
>> You may be interested to know that in the 1979s and 1980s we made daily
>> rounds with the radiologist and interpreted the films together.  This was
>> unequivocally produced remarkable returns and was a good investment of time
>> in a high-tech intensive care unit.  Better communication is always
>> desirable.  I am reminded of a quote from George Bernard Shaw:
>>
>>
>>
>> “The single biggest problem in communication is the illusion that it has
>> taken place."
>>
>>
>>
>> Alan H. Morris, M.D.
>>
>> Professor of Medicine
>>
>> Adjunct Prof. of Medical Informatics
>>
>> University of Utah
>>
>>
>>
>> Medical Director, Urban Central Region Pulmonary Function Laboratories
>>
>> Pulmonary/Critical Care Division
>>
>> Sorenson Heart & Lung Center - 6th Floor
>>
>> Intermountain Medical Center
>>
>> 5121 South Cottonwood Street
>>
>> Murray, Utah  84157-7000, USA
>>
>>
>>
>> Office Phone: 801-507-4603
>>
>> Mobile Phone: 801-718-1283
>>
>>
>>
>>
>>
>> *From: *Leonard Berlin <lberlin at LIVE.COM>
>> *Reply-To: *Society to Improve Diagnosis in Medicine <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Leonard Berlin <lberlin at LIVE.COM>
>> *Date: *Tuesday, January 26, 2016 at 05:56
>> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> *Subject: *Re: [IMPROVEDX] Support Tests.
>>
>>
>>
>> Without any doubt whatsoever, the radiology literature is replete  in
>> confirming that the more clinical information  that is provided to
>> radiologists.  the more accurate will be their reports.
>>
>> Will clinical info on occasion bias the radiologist?  Yes, but very
>> rarely.  Any potential "harm" of providing  the radiologist with clinical
>> info is far, far,  outweighed by the benefit.
>>
>> Lenny Berlin, MD
>> Professor of Radiology,
>> Rush University and
>> Uiv. Ill, Chicago
>>
>>
>>
>> > Date: Tue, 26 Jan 2016 04:30:40 +0000
>> > From: Joe.Grubenhoff at CHILDRENSCOLORADO.ORG
>> > Subject: Re: [IMPROVEDX] Support Tests.
>> > To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> >
>> > Is there not data that indicated that giving more, not less,
>> information to a radiologist in a requisition improves the accuracy and
>> clinical utility of the interpretation? As an PEM physician I teach the
>> residents that our radiology colleagues are consultants just like a
>> cardiologist. Call them, ask what the most reliable study is for the
>> clinical question. Saves time and money by avoiding unnecessary or
>> inappropriate exams that don't resolve or often muddy the clinical picture.
>> >
>> > Sent from Skynet
>> >
>> > > On Jan 25, 2016, at 21:12, Elias Peter <pheski69 at GMAIL.COM> wrote:
>> > >
>> > > I addressed my concerns to the radiologists and pathologists, not the
>> hospital. They agreed that changes were needed, did not always agree on
>> what changes were needed, and most were willing to try things to see what
>> did and didn’t help.
>> > >
>> > > The administrative structure was not impressed with the clinical
>> request that we expend some of the institutions resources (time, IT work,
>> communication system to discuss what we were doing) and the requests
>> eventually died out.
>> > >
>> > > I understand the concern that clinical information might bias a
>> radiologist’s reading. The same thing could be said about the patient
>> history biasing my exam, test ordering, assessment or plan. The purpose of
>> information is to point us in some direction. The solution to this is NOT
>> to hide clinical information from the radiologist/pathologist (or the
>> patient) but to make as much information available to as many people on the
>> team as possible.
>> > >
>> > > Peter Elias
>> > >
>> > >
>> > >> On 2016.01.25, at 9:08 PM, Stefanie Lee <stefanieylee at GMAIL.COM>
>> 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?
>> > >> 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.
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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