In Search of a Common Definition of Dx Error

Mittal, Manoj K MITTAL at EMAIL.CHOP.EDU
Fri May 6 15:24:43 UTC 2016


Here! Here!

Well said, Lenny!


Manoj



Manoj K. Mittal, MD, MRCP (UK), FAAP, FACEP
Medical Director,
Pediatric ED, St Mary Medical Center, Langhorne, PA
Attending Physician
Co-Chair, QI and Patient Safety Committee
Division of Emergency Medicine
The Children's Hospital of Philadelphia
Associate Professor of Clinical Pediatrics
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA
Tel: (215) 590 1944
Fax: (215) 590 4454


________________________________
From: Leonard Berlin <lberlin at LIVE.COM>
Sent: Friday, May 6, 2016 10:55 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] In Search of a Common Definition of Dx Error

Over the past several days I have enjoyed reading the long list of commentaries submitted by very bright and caring physicians.  medical-associated people,  and researchers,  on the subject of the frequency of medical errors and their  role in causing death of patients. This has led me to conclude the following undeniable fact:

 NOBODY KNOWS HOW MANY MEDICAL ERRORS ARE COMMITTED, AND NOBODY KNOWS HOW MANY PEOPLE ARE KILLED BY MEDICAL ERRORS!

The articles by Makary and others that calculate numbers related to medical errors and patient injury are nothing more than statistical projections,  extrapolations, estimates, and conjectures.

Makary, Johns Hopkins, and the BMJ got great international headlines by "estimating" that 251,454 patients die of medical mistakes annually. Needless to say, the word "estimating" doesn't appear very much,  if at all, in the headlines and limited text proclaimed  in newspaper and TV news reports.

Today, physicians  in all specialties are presumably  practicing   "evidence-based-medicine."

When it comes to medical errors, there is no "evidence!"

Yes, focusing attention on medical errors is certainly productive, and indeed encourages all of us to improve medical care safety and reduce errors.  And clearly, supporting organizations such as  SIDM is a step in the right direction.

We should be transparent to the public, but frightening everyone and causing them to lose confidence in their physicians is counterproductive. Our message to the public should be an honest one:  MEDICAL ERRORS DO OCCUR, BUT WE DO NOT KNOW, AND WILL NEVER KNOW, HOW MANY PATIENTS DIE DUE TO A MEDICAL ERROR; HOWEVER, WE ARE WORKING ON WAYS TO REDUCE THEM.

Lenny
________________________________
Date: Thu, 5 May 2016 14:23:22 -0500
From: ruthryan at COX.NET
Subject: [IMPROVEDX] In Search of a Common Definition of Dx Error
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG


To all,



Allow me to pick the finest brains on this topic.  Should SIDM adopt one of these definitions below, or craft a combination of these elements?  How would you define it?



DEFINITIONS OF DIAGNOSTIC ERROR




Author


Source or Citation


Definition


Mark Graber


Diagnostic errors in medicine: a case of neglect. Jt Comm J Qual Patient Saf. 2005.



Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005


Medical diagnoses that are wrong, missed, or delayed.



A diagnosis that was unintentionally delayed (sufficient information was available earlier), wrong (another diagnosis was made before the correct one), or missed (no diagnosis was ever made), as judged from the eventual appreciation of more definitive information.




Hardeep Singh




Helping healthcare organizations to define diagnostic errors as opportunities in diagnosis. Jt Comm J Patient Safety, 2014.




A breakdown in the diagnostic process and a missed opportunity to have made the diagnosis more accurately or more efficiently…regardless of whether there was patient harm.


Gordon Schiff et al


Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors. Arch Intern Med. 2009


Any mistake or failure in the diagnostic process leading to a misdiagnosis, a missed diagnosis, or a delayed diagnosis. This could include any failure in timely access to care; elicitation or interpretation of symptoms, signs, or laboratory results; formulation and weighing of differential diagnosis; and timely follow-up and specialty referral or evaluation.




Institute of Medicine


Improving Diagnosis in Health Care, 2015 report Institute of Medicine (IOM)


The failure to establish an accurate and timely explanation of the patient's health problem(s) or to communicate that explanation to the patient.






BEST DEFINITION OR COMBINED DEFINITION:



Fill in the blank








Ruth



Ruth Ryan RN, BSN, MSW, CPHRM

Medical writer

Risk management/patient safety

Continuing medical education

Telephone (504) 256-8797

Email ruthryan at cox.net<mailto:ruthryan at cox.net>

[canstockphoto14944494_revised]





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

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http://www.improvediagnosis.org/






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


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