death certificates and diagnostic error

Elizabeth Regan lizregan53 at GMAIL.COM
Fri May 6 16:23:47 UTC 2016

This is such a painful topic for conscientious physicians who struggle to do the best.  I cringe thinking about errors I have made in my 30+ years of practice and do not revel in the thought of more exposure or tracking.

However, as a human being who depends on the careful work of physicians and has way too many stories of medical diagnostic error in my friends, family and my own encounters with the medical profession I feel very strongly that we need to characterize the problem and make incremental progress to reduce it.

I have no enthusiasm for electronic medical records in the fight.  They are full of bad data due to careless data entry, lack of verification and no effort to update.  I see lots of copy/pasting of wrong information.

EMRs have not come close to the early promises that they would help us generate comprehensive differential diagnoses or the ability to sort through enormous amount of data.  You can make a table of lab results.  You can see the current medications ( with lots of errors).  

What the EMR does not foster is thoughtful integration of symptoms, signs and test results.  It does not remind physicians of basic clinical epidemiology principles in interpreting test results.

Comment on aviation - many years as pilot and copilot.  If you screw up - you are still in trouble.  

Individuals that society entrusts are expected to be perfect in some sense.  

Punitive actions are a problem for the physician who is trying hard to do right, but for the subset of careless people you need to have boundaries and consequences.

I think it could be easier for all if we were able to look at these errors as the common events that they are and dispassionately try to reduce them.  The current, highly charged,  guilty or not guilty system leads to lies, denial and continued problems.  So there need to be several directions taken.

Maybe within organizations and medical groups there could be protected analysis of errors with the goal of quality improvement.  Perhaps an initiative taken as a pilot project to evaluate whether tracking and careful analysis of root causes would help.  Maybe a value  based educational program as another pilot initiative - what would you want to teach physicians about diagnostic error prevention.  How to structure a practice to prevent such errors.  regular time for colleagues to sit down and review cases - tough to do when there are patients waiting or you need to see more in order to make salaries and bills.

Are there health care partners who would gain from reductions in errors.  Would they fund some pilot projects

Do we have enough research to lead/design a pilot improvement project?  


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

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