In Search of a Common Definition of Dx Error

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Fri May 6 17:11:45 UTC 2016


I am a patient who had a serious misdiagnosis. For eight months I was
treated for a 'tiny, scabbed over stomach ulcer, which was deemed to
account for a hemoglobin of 6.6. The pathology report denied any evidence
of a'frank ulcer' and noted the absence of H. pylori.  Invasive tests, etc,
etc, until I was rediagnosed with cirrhosis, thanks to my purported
alcoholism. Preparatory to a liver biopsy 'to confirm the cirrhosis', two
swipes of the ultrasound wand revealed a 10cm kidney tumor.  A CT of the
chest showed 100s of mets.  Ulcer to metastatic kidney cancer in eight
months of careful compliance with the doctor's recommendations...

There was NO place for me to report this error, no real response from my
doctor, except silence and a haphazard recommendation to "find someone
else".  Knowing full well that I would lose a lawsuit, I sued anyway, and
lost during an agreed upon mediation.  I had only the hope that this doctor
and his nearest and dearest colleagues might never dismiss the seriousness
of such a low hemoglobin, or of a pathology report that clearly should have
caused a review of the diagnosis.

Had there been a place outside the litigation world where I might have
reported the error, had a review of that which led to the error, a change
in policy whereby the patient received the pathology report and others, I
would not have sued.

We must create a system to collect these reports from patients and doctors.
It must legitimate and transparent, readily accessible to patients, and
have similar feedback loop to the patient and doctors. Do this through the
hospital(s) where the doctor has privileges, so that there is also an
institutional review of the situation and the skills of the doctor and the
systematic problems that might add to it.  Changes would come very quickly.


Peggy Zuckerman

Peggy Zuckerman
www.peggyRCC.com

On Fri, May 6, 2016 at 8:24 AM, Mittal, Manoj K <MITTAL at email.chop.edu>
wrote:

> 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
>
> [image: canstockphoto14944494_revised]
>
>
>
>
>
> ------------------------------
>
>
> 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
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.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
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.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
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>






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


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