Diagnostic Infrastructure

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Fri Feb 5 18:21:18 UTC 2016


I would assume that a diagnosis of plague, though very important for
catching an outbreak and monitoring its spread effectively, is far less a
problem than diagnosing many other misdiagnosed diseases.  We in the kidney
cancer world--and parallels in other such cancers--are painfully aware of
the length of time it can take to get a diagnosis, even for disease that is
advanced.

Where are the low-hanging fruits, which when caught early, are amenable to
intervention?  Would greater use of non-invasive techniques such as
ultrasound be more helpful before going to a small-bowel study in the
gastro world?

One clue; when a woman of menopausal age is about to be given a handful of
anti-depressants for the pain and discomfort she reports over several
appointments, this may be time to consider thyroid issues or GU cancers.
Just venting a bit here after a friend was diagnosed with medually thyroid
cancer after she was told her ailments were just 'age' and 'stress'.

Peggy Zuckerman

Peggy Zuckerman
www.peggyRCC.com

On Fri, Feb 5, 2016 at 7:54 AM, Alan Morris <Alan.Morris at imail.org> wrote:

> Rob:
> If by infrastructure you mean decision-support, then I agree.  If you mean
> education and the usual traditional means we have used, I think this will
> have little effect.  We just discussed a fatal case of plague in Medial
> grand Round.  There is no way to help clinicians, in the absence of an
> epidemic, to quickly diagnose plague.  It is too infrequent.  We could,
> however, introduce a rapid diagnostic test that might become routine, if it
> had a low enough false positive rate.
>
> Decision support is the key to helping humans because of their limited
> cognitive ability.
>
> Alan
> 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: Robert Bell <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
> Reply-To: Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Robert Bell <rmsbell200 at YAHOO.COM>
> Date: Thursday, February 4, 2016 at 23:02
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] Diagnostic Infrastructure
>
> Thanks Helene,
>
> I had not thought of journalists. but they are so important. The AMA
> quotes each day in their daily sendings many newspapers. It seems as this
> is one of the main ways that medical information is spread.
>
> Rob Bell
>
>
>
> Sent from my iPad
>
> On Feb 4, 2016, at 2:13 PM, HM Epstein <hmepstein at GMAIL.COM> wrote:
>
> Robert:
> Thank you for posting that link. It brings up an excellent point as well
> for freelance journalist like me. I often have to go to extreme measures to
> get copies of full studies. Most journalists don't bother which is why
> consumer press coverage of medical news is often limited to what the press
> release says. Those of us who like to dig a little deeper lose the ability
> to do so in a timely fashion in contrast to the echo chamber of most press
> outlets.
>
> Now I'm going to check out #ICanHazPDF which the article refers to as an
> end run around pay walls.
>
> Best,
> Helene
>
>
> *--  *
> * <http://hmepstein.com>hmepstein.com <http://hmepstein.com> *
> *@hmepstein*
> *Mobile: 914-522-2116 <914-522-2116>*
>
> *Sent from my iPhone*
>
>
>
> On Feb 4, 2016, at 3:36 PM, robert bell <
> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org>
> 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>
> 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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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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