Diagnostic Infrastructure

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Thu Feb 4 21:23:27 UTC 2016

How do we get the error rate down when there is such diverse range of
issues that cause such error?  We can certainly approach those known errors
in a linear fashion, but that will have little impact in the near term,
except in those cases.

Just as Bell has pointed out that neither doctors nor patients are getting
the best possible information in a timely manner, that problem is not
limited to Wikipedia or OpenSource documents.  A great deal of focus has
been made on the difficulty of replicating clinical trial studies, of the
shifts in the reported outcomes away from the initial goals of those
studies, and of studies which are sadly incomplete of the data which would
give clinicians greater and more reliable guidance in treatment.  Then
there is the issue of the acceptance of change which might derive from
those studies, said by some require at least 14 years for 50% of the
clinicians incorporating even new guidelines in their practices.

Rather than focusing on one topic or type of error, there must be a
cultural change in the diagnostic process.  Part of that--and there are a
myriad of parts--is permitting and encouraging patients to receive and read
their complete medical records.  Following that is the need for patients to
correct the errors in those records, and to be able to share them freely
with other family members or providers.

There also needs to be a way for a misdiagnosis or concern for such to be
reviewed by a responsible party.  The sheer number of patients who are
treated for something which they do not have, and at the expense in time,
life and limb, is staggering.  However, imagine the resources to be freed
up when they are not dispersed incorrectly and with greater long-term
cost.  We all will benefit from approaching this as cultural shift, as
significant in society as was the civil rights and womens' movements.

This while thinking as a board member of the Society for Participatory
Medicine (participatorymedicine.org),as well as patient advocate.

Peggy Zuckerman

On Thu, Feb 4, 2016 at 12:36 PM, robert bell <
0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

> To all on the list.
> A friend kindly sent me this:
> http://www.brookings.edu/blogs/techtank/posts/2016/01/11-open-access-scientific-knowledge
> It seems that much of the information that we see is obtained from Open
> Access information not from closed source Scientific Journals. Wikipedia
> editors are 47 percent more likely to use Open Source Journals for their
> information.
> Consequently, the the public and probably also physicians are not getting
> the very best scientific information in a timely way.
> This brings up the issue of what I will call the Diagnostic Medical
> Infrastructure.
> If the infrastructure is *not* sound, information is not being
> distributed in the best way to physicians and the public to focus on
> evidence based medicine, physicians are missing a “raised" PSA test when
> someone has had a prostatectomy, and a large percentage of radiologists are
> missing an image of a "Gorilla” on an X-ray, and also a thousand and one
> other problems, particularly in the communication area, that in turn all
> lead to error, how can we hope to successfully first tackle diagnostic
> errors?
> If the current diagnostic error rate on all patients is say 30% would it
> not be better to get this figure down before focussing on improving
> diagnoses as a whole? It may be possible to tackle the standard errors and
> diagnostic errors together in some way but surely some of the standard
> errors have to be dealt with first to save lives and injury.
> Triaging some of these problems, correcting/improving them, could quickly
> start reducing the current diagnostic errors.
> Should we first be focussing on the Diagnostic Medical Infrastructure?
> Should our focus first be on the best ways to save lives and stop patient
> injury?
> Robert M. Bell, M.D.
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> Medicine
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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