death certificates

robert bell rmsbell200 at YAHOO.COM
Fri May 6 00:07:48 UTC 2016


What are the ways to promote transparency?  Doe anything work reliably?

Rob
> On May 5, 2016, at 1:50 PM, DR WILLIAM CORCORAN <williamcorcoran at SBCGLOBAL.NET> wrote:
> 
>  
> Transparency elicits outrage, insight, and action.
>  
> Opaqueness elicits complacency, ignorance, and toleration.
>  
> Take care,
>  
> Bill Corcoran
> 
>  
> William  R. Corcoran, Ph.D., P.E.
> 21 Broadleaf Circle
> Windsor, CT 06095-1634
> 860-285-8779
> William.R.Corcoran at 1959.USNA.com
> http://www.linkedin.com/in/williamcorcoranphdpe <http://www.linkedin.com/in/williamcorcoranphdpe>
> https://www.box.com/shared/kfxg1lt9dh 
> 
> 
> 
> From: Joe Graedon <jgraedon at GMAIL.COM>
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
> Sent: Thursday, May 5, 2016 4:35 PM
> Subject: Re: [IMPROVEDX] death certificates
> 
> I am a firm believer in the principles of reward and punishment. By that I mean, people, animals, and all sorts of other creatures do what gets them rewards, treats, food, toys, whatever. They also try to avoid the things that cause them distress. 
> 
> Our medical system rarely rewards health care professionals for reporting errors. If anything, physicians are punished by their employers, insurance companies and yes, malpractice lawyers, for being transparent about mistakes, especially those that lead to death. 
> 
> I only imagine we will see change if we come up with strategies to reward physicians, nurses and all others involved in health care to share mistakes the way pilots are encouraged to share close call information. We need billions of dollars in federal money (think the National Institute of Error Prevention-NIEP) to come up with solutions to diagnostic errors and treatment mistakes. And we need to punish institutions that hide their mistakes. 
> 
> Reward the behavior we wish to encourage. Punish the behavior we wish to disappear. 
> 
> Sorry to be so blunt.
> 
> Joe
> 
> 
>> On May 5, 2016, at 3:57 PM, Phillip Benton, MD, JD <0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG <mailto:0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> wrote:
>> 
>> Liz,
>> 
>> Is such review not essentially what Lucien Leape and colleagues did in the Harvard Medical Practice study (N Engl J Med. <http://www.ncbi.nlm.nih.gov/pubmed/?term=Leape+L%2C+Brennan+T%2C+Laird+N%2C+et+al.+The+nature+of+adverse+events+in+hospitalized#> 1991 Feb 7;324(6):377-84) 25 years ago, referenced in the IOM  report To Err Is Human (1999)? The several reviews that followed were systematically re-reviewed  by John James just 3 years ago (J Patient Saf. <http://www.ncbi.nlm.nih.gov/pubmed/?term=James+JT%2C+Journal+of+Patient+safety+2013#> 2013 Sep;9(3):122-8.). 
>> 
>> Can we deny the problem?  NO.  Can we arrive at a consensus definition (wth qualifiers) and ascribe an ICD code (with modifiers)?  Most probably YES if anyone will take it on.
>> 
>> Phil Benton, MD, JD
>> Atlanta, GA
>> 
>> -----Original Message-----
>> From: Elizabeth Regan <lizregan53 at GMAIL.COM <mailto:lizregan53 at GMAIL.COM>>
>> To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
>> Sent: Thu, May 5, 2016 2:24 pm
>> Subject: [IMPROVEDX] death certificates
>> 
>> I would not favor adding medical error to death certificates for a variety of reasons but the chief one being that it is so hard to define and while is obvious to those who want to see improvement, it is less obvious to those who want to avoid the concept. At the point where there is broader consensus on how to identify and reduce medical error (especially diagnostic error) I think it will be easier to record and track the event.
>> 
>> I believe strongly that it is critical to do that, but we are not there yet.
>> 
>> I have just completed a project to adjudicate cause of death in nearly a 1000 deaths for a large cohort study. The project involves reviewing both death certificates and medical records. At that level of review I did not see evidence of diagnostic error or other errors. Now that I consider the project in light of this discussion - I guess that is interesting.
>> 
>> I don’t interpret this to mean that none of those subjects experienced error, but rather to reflect on the invisibility of error in our record keeping.
>> 
>> I wonder about the feasibility of re-reviewing the data with a more critical eye and finding more. However, I don’t really think I would find much.
>> 
>> Liz Regan
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Robert M. Bell, M.D., Ph.C.
P.O. Box 3668
West Sedona, AZ  86340-3668
USA
Tel: Fax: 928 203-4517









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


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