Support Tests.

Tom Benzoni benzonit at GMAIL.COM
Tue Jan 26 22:16:03 UTC 2016


Combining the 2 ideas.
http://www.npr.org/sections/health-shots/2013/02/11/171409656/why-even-radiologists-can-miss-a-gorilla-hiding-in-plain-sight
Or Google "NPR radiologist gorilla"
First link.
Tom
On Jan 26, 2016 12:51, "Elias Peter" <pheski69 at gmail.com> wrote:

> I believe there was at least one study where clinical history very
> significantly changed the frequency with which pulmonary angiograms were
> read and pulmonary embolus, normal or indeterminate.  I do not have the
> reference handy and I do not know if it has been replicated.
>
> I do know that it is a basic ‘law’ of human cognition that we are more
> likely to see things we expect or are looking for.  Ask any motorcyclist
> about it - they will tell you that drivers look to see if there is a car
> before they change lanes and then hit the clearly visible motorcyclist. Or
> read The Invisible Gorilla.
>
> Peter
>
> On 2016.01.26, at 11:45 AM, Mark Graber <mark.graber at IMPROVEDIAGNOSIS.ORG>
> wrote:
>
>
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> <Toy  2004 - Accuracy of Dx Tests Read With and Without Clinical
> Information - Systematic Review.pdf>
>
> There was a helpful systematic review published on 2004 on the value of
> providing clinical input to improve the accuracy of radiological imaging
> interpretation.  The analysis concluded that clinical input DID improve
> accuracy in all of the studies they examined.  If anyone has more recent
> publications on this I'd be interested to see them.
>
> In an earlier listserv discussion we raised the question about WHEN this
> information should be provided  As I recall the discussion, the feeling was
> that the clinical info should be reviewed AFTER the radiologists initial
> review of the imaging study. This would be the equivalent of getting a
> second opinion from yourself - invoking "System 2" to do its job of
> checking on "System 1".  If you reviewed the clinical information first,
> this might bias the reader to search for findings that would support the
> clinical impression, although I'm aware of at least one study where this
> biasing effect didn't seem very powerful.
>
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> <Berbaum - 1986 - Tentative diagnoses facilitate the detection of diverse
> lesions in chest radiographs.pdf>
>
>    Mark
>
> Mark L Graber MD FACP
> President, SIDM  www.improvediagnosis.org
> Senior Fellow, RTI International
> Professor Emeritus, SUNY Stony Brook, NY
> 919 990-8497
>
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> <Logo - Medium PNG.png>
>
> On Jan 26, 2016, at 8:04 AM, Michael Grossman <Michael.Grossman at MIHS.ORG
> <Michael.Grossman at mihs.org>> wrote:
>
> Your comment reminded me that when I trained (1960’s) and started practice
> in the “70’s I reviewed every film every day with the radiologist simply by
> calling ahead and scheduling the meeting.
> Michael Grossman , MD MACP
> Professor of Medicine and medical informatics University of Arizona
> VP Academic Affairs MIHS
>
>
> *From:* Alan Morris [mailto:Alan.Morris at IMAIL.ORG <Alan.Morris at IMAIL.ORG>]
>
> *Sent:* Tuesday, January 26, 2016 8:20 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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