AW: [IMPROVEDX] Burn out

Kodolitsch von, Yskert kodolitsch at UKE.DE
Sun Feb 7 17:25:17 UTC 2016


You really should read my article on
http://cogentoa.tandfonline.com/doi/full/10.1080/2331205X.2015.1109742
You may see that it is not quite easy to tell what is the right thing in medicine today. Money is in and will not get out of the system, for instance.
In IMS I at least approach some of the bottom lines how to run modern hospital medicine while staying humanistic.
I am happy to receive comments.

Yskert v. Kodolitsch
Oberarzt
Centre of Cardiology and Cardiovascular Surgery
Department of Cardiology/Angiology
University Medical Centre Hamburg-Eppendorf, Hamburg
Martinistrasse 52
20246 Hamburg; Germany
Tel.   ++4940 7410 57328
Fax   ++4940 7410 54840
E-mail: kodolitsch at uke.de

Von: Robert Bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Gesendet: Mittwoch, 3. Februar 2016 17:05
An: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Betreff: Re: [IMPROVEDX] Burn out

Can you think of a bottom up "revolution" in medicine that has been succesful? There have been occasional strikes in Medicine around the world from time to time, and they have had a little, but not major success.


But I suppose it would be worth a try. An organised campaign from physicians in the workplace with specific recommendations for practice. Would that work?


Rob Bell, M.D.

Sent from my iPad

On Feb 2, 2016, at 8:19 PM, Alan Morris <Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>> wrote:
No, I do not believe that will be successful.

It will require a bottom-up, clinician driven implementation of an exportable clinical decision-support tool supported with compelling clinical results from prior use.  We have used this strategy with success for several detailed computer protocols exported to multiple institutions.
Alan
From: Rob Bell <rmsbell200 at yahoo.com<mailto:rmsbell200 at yahoo.com>>
Date: Tuesday, February 2, 2016 at 20:03
To: Alan Morris <Alan.Morris at imail.org<mailto:Alan.Morris at imail.org>>, "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Burn out

Can this be done with recommendations and without any enforcement, financial or otherwise?

Rob Bell, M.D.

Sent from my iPhone

On Feb 2, 2016, at 7:47 PM, Alan Morris <Alan.Morris at imail.org<mailto:Alan.Morris at imail.org>> wrote:
Rob:
I begin my courses on this subject with a discussion of human cognitive limitations, to open critical thinking about those things we think we do “the right way.”  I then discuss,in a series of multiple lectures or flipped classrooms, unnecessary variation in medicine, knowledge engineering and its psychological basis, implicit and explicit information, replicable detailed computer protocol methods and the clinical results they achieve, how we unburden the overtasked clinician, the development of detailed computer protocol rules, and decision-support in ordinary life activities.  The feasibility of doing this is well-established.

To fix the problem we must convince policy making institutions (IOM, and government included) and funding institutions (NIH, AHRQ… included) to focus on replicable methods that provide personalized instructions and standardize clinical decision-making.  This is a domain with multiple subtopics.  I would be happy to discuss this you or other interested colleagues.

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<tel:801-507-4603>
Mobile Phone: 801-718-1283<tel:801-718-1283>


From: robert bell <rmsbell200 at yahoo.com<mailto:rmsbell200 at yahoo.com>>
Date: Tuesday, February 2, 2016 at 16:51
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Alan Morris <Alan.Morris at imail.org<mailto:Alan.Morris at imail.org>>
Subject: Re: [IMPROVEDX] Burn out

Alan, if you were King what would you do to remedy?!

Rob Bell, M.D.
On Feb 2, 2016, at 2:25 PM, Alan Morris <Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>> wrote:

Dr. Hoon makes an unassailable, but incomplete argument.  We, of course, should focus on patient need and practice good medicine – that is a given and I applaud his engagement with trainees.  However, evidence clearly indicates that unaided clinicians, no matter how well-intended, do not do a good job of linking care to best evidence.  Error and inappropriate care are rampant and account for 1/3 of our $3Trillion national healthcare expenditure.  We clinicians must engage the use of tools that enable us to increase compliance with evidence-based care from the common 30% to 95% or more.  This is clearly feasible and achievable – but the culture of medicine has not yet grasped this reality.  Trainees are focused on learning how to execute the tasks of medicine – they are not focused on, or perhaps even interested in, the inadequacies of health care delivery.
Alan H. Morris, M.D.

From: "Regan, Elizabeth" <ReganE at NJHEALTH.ORG<mailto:ReganE at NJHEALTH.ORG>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "Regan, Elizabeth" <ReganE at NJHEALTH.ORG<mailto:ReganE at NJHEALTH.ORG>>
Date: Tuesday, February 2, 2016 at 09:03
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Burn out

Dear Ji,
I agree with you enthusiastically on your focus.  Our job as physicians is to do the right thing and care for illness/patients.  I would argue that there is some relationship to burn-out when we no longer feel good about the work we are doing.  Short-cutting care for cost reasons feels crummy to me and I have long resisted it.  I love finding the right diagnosis after carefully sorting through the symptoms and possibilities.  It is so satisfying that it brings me back to the clinic happily.
Liz

From: "Baang, Ji Hoon" <JiHoon.Baang at TUHS.TEMPLE.EDU<mailto:JiHoon.Baang at TUHS.TEMPLE.EDU>>
Reply-To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "Baang, Ji Hoon" <JiHoon.Baang at TUHS.TEMPLE.EDU<mailto:JiHoon.Baang at TUHS.TEMPLE.EDU>>
Date: Tuesday, February 2, 2016 at 1:11 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Burn out

My little contribution in changing the culture when I round with my residents and students is that I tell them to ignore the administrators. I tell them to focus on taking care of your patients, learning medicine and being a good doctor. Write notes to communicate and tell people what you are thinking. If a patient wants to stay because she/he just wants to stay for 1 more night because it is cold and rainy outside, I tell them to let the patient stay. And at the end of rounds, I ask our team, “So how do you think we did with our length of stay? Our readmission rate? Our patient satisfaction score?” And more often than not, we end up doing a decent job and make our administrators happy. And most importantly, we all have fun taking care of our patients.

After my training, I worked in industry for a few years. I learned a little bit about the business literature. I think what we are seeing in medicine closely resemble what pharma did in the 1980s. Emphasizing metrics and profit to the extent that it is changing our culture. Pharma used to be a well respected business until sales and marketing became the main driver of its business. And we all know what happened. The most successful and sustainable businesses really focus on what is really important. The customer, and in our case the patient. Metrics are their for our patients and not for profit. And so if you focus on the patient, the metrics often fall into place. For example, if you have a patient in front of you and you know the diagnosis on day 1, your length of stay will not be long. It is often the patient with no diagnosis and no plan that tends to stay for many days and weeks.

I think a lot of the burnout issue comes from the simple fact that people are just not having fun, because they are focusing on issues that they don’t really care about. I know I am oversimplifying a complex problem but even complex problems have a root cause. In this case, I think the root cause is that many are not able to find meaning in the work that they do anymore.

I’ll end with a quote from a business man that I think is relevant to what is happening in medicine today:

We try to remember that medicine is for the patient. We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.      - George Merck

Ji

Ji Hoon Baang, M.D.
Assistant Professor of Clinical Medicine
Internal Medicine Subinternship Director
The Lewis Katz  School of Medicine at Temple University
Philadelphia, PA
(T) 215-707-1622
(F) 215-707-0943


On Feb 1, 2016, at 3:35 PM, Vic Nicholls <nichollsvi2 at GMAIL.COM<mailto:nichollsvi2 at GMAIL.COM>> wrote:

Mr. Maude,

When hospitals motto appears to be #profitoverpatients, I don't think they will care about the workerbee doctors. Its pretty obvious they don't, unless it is to keep the money rolling in to pay for admin salaries.

Vic


On 2/1/2016 6:17 AM, Jason Maude wrote:

Alan
This is very depressing. Are you seeing any impact from the IOM report yet in helping to change culture? I am expecting/hoping that the report will start being discussed by hospital boards and this will eventually translate in some sort of action which could include providing and encouraging the use of decision support as you describe.
Regards
Jason

  Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com<http://www.isabelhealthcare.com>  <http://www.isabelhealthcare.com/>







On 30/01/2016 16:30, "Alan Morris"<Alan.Morris at IMAIL.ORG<mailto:Alan.Morris at IMAIL.ORG>>  wrote:


Thanks - this is likely to continue until we, as a profession, focus on
the core problem:  the overtasked physician, asked to do humanly
impossible decisions without effective decision support.  I believe we
will be mired in this problem set unless we target automatic control of
medical tasks (closed loop protocols) with adequately detailed computer
protocols.  This requires a cultural change and recognition that the
Hippocratic model (the expert model) is necessary but by itself
insufficient.  Most of the time I feel as if I am talking to a wall.
Have a nice day and Happy New Year.
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<tel:801-507-4603>
Mobile Phone: 801-718-1283<tel:801-718-1283>






On 1/30/16, 08:57, "Robert Bell"
<0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>>  wrote:


The AMA Morning Rounds today has an excellent article on Physician
burnout. It mentions Errore in Medicine.

Rob Bell, M.D.



Sent from my iPad
To unsubscribe from the IMPROVEDX:
mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

Address messages to:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/  (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in
Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a
href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPRO VEDX&A=1"  target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SU
BED1=IMPROVEDX&A=1</a>
</p>
To unsubscribe from the IMPROVEDX:
mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

Address messages to:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/  (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1"  target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a><http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1%3c/a%3e>
</p>
To unsubscribe from the IMPROVEDX:
mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

Address messages to:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/  (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1"  target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a><http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1%3c/a%3e>
</p>

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a><http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1%3c/a%3e>
</p>


________________________________

This electronic message is intended to be for the use of the named recipient, and may contain information that is confidential or privileged. This communication may contain protected health information (PHI) that is legally protected from inappropriate disclosure by the Privacy Standards of the Health Insurance Portability and Accountability Act (HIPAA) and relevant Pennsylvania Laws. You can direct questions concerning PHI or HIPAA to the Corporate Compliance and Privacy Officer at (215) 707-5605. If you are not the intended recipient, please note that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this message in error, you should notify the sender immediately by telephone or by return e-mail and delete and destroy all copies of this message.
________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX


Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


NOTICE: This email message is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.  ­­
________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX


Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX


Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


Robert M. Bell, M.D., Ph.C.
P.O. Box 3668
West Sedona, AZ  86340-3668
USA
Tel: Fax: 928 203-4517




________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/
--

_____________________________________________________________________

Universitätsklinikum Hamburg-Eppendorf; Körperschaft des öffentlichen Rechts; Gerichtsstand: Hamburg | www.uke.de
Vorstandsmitglieder: Prof. Dr. Burkhard Göke (Vorsitzender), Prof. Dr. Dr. Uwe Koch-Gromus, Joachim Prölß, Rainer Schoppik
_____________________________________________________________________

SAVE PAPER - THINK BEFORE PRINTING


To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

HTML Version:
URL: <../attachments/20160207/249addca/attachment.html>


More information about the Test mailing list