In Search of a Common Definition of Dx Error

robert bell rmsbell200 at YAHOO.COM
Sun May 8 21:13:40 UTC 2016


Tom, you bring up some good points.

Does litigation as currently executed in medicine reduce errors in medicine.

Do bigger settlements make any difference? Do those with settlements have less subsequent errors? 

Is there any data. Checking the box forever is not correct - that alone should be changed with litigation reform.

This whole confusing mess does need changing. I would like to see as part of any settlement the hospitals/facilities having to do something to show improvement. That could alone force the industry to keep good records. Could that possibly happen?  How would you get that started?

The focus at all times should be the patient.

Rob Bell


> On May 8, 2016, at 10:08 AM, Tom Benzoni <benzonit at gmail.com> wrote:
> 
> Dr. Bell:
> 
> Interesting question you ask.
> 
> When I took Medical Jurisprudence >> 30 years ago, the medical system was more open (and less capable.)
> 
> We paid MedMal fees then and now; we calculate MedMal costs into our fees and lifestyle. So, really, it isn't about the money. Not to us. But is is to nearly everyone else. (I don't think it's usually about the $ to the patient/family, either, early on. That changes, I think, as part of the suing process; that process demands money to move forward and resolution/forgiveness would stop that process/money flow.)
> 
> Authorized in 1986 and commencing operation in 1990, NPDB changed everything. There came into existence a central database of all the bad things a Dr was alleged to have done as reported by legal processes. (There is no corollary between committing malpractice and losing a lawsuit, either positive or negative (You can be bad and not get sued and be good and get sued. Losing the suit has no corollary to damage, either. A matter for another day.)
> 
> Now, when sued, win/lose/draw, there is a permanent black mark that must be reported on any application submitted. Additionally, we are ordered, under threat of no insurance coverage, to shut up and not talk to anyone (which is exactly the opposite of recommendations but does further the interests of those moving the process, above.)
> 
> Given this, Medmal suits must be understood as criminal (not civil; we have to Check the Box forever) prosecutions with a 49/51 burden of proof and soft rules of evidence. Very low expectations for creating meaningful change must be set for such a system.
> 
> tom
> 
> On Fri, May 6, 2016 at 7:12 PM, robert bell <0000000296e45ec4-dmarc-request at list.improvediagnosis.org <mailto:0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
> Lenny, 
> 
> Could changing litigation laws for the Medical Industry help us collect good error data?
> 
> If yes, should we do something now?
> 
> My gut feeling tells me with all the constant small errors that HCPs make, that deaths are probably more than 100,000 a year - but please prove me wrong!  Is that about 17 per hospital per year?
> 
> Rob Bell
> 
> 
> 
> 
> 
> 
>> On May 6, 2016, at 8:24 AM, Mittal, Manoj K <MITTAL at EMAIL.CHOP.EDU <mailto: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 <tel:%28215%29%20590%201944>
>> Fax: (215) 590 4454 <tel:%28215%29%20590%204454>
>> From: Leonard Berlin <lberlin at LIVE.COM <mailto:lberlin at LIVE.COM>>
>> Sent: Friday, May 6, 2016 10:55 AM
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto: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 <mailto:ruthryan at COX.NET>
>> Subject: [IMPROVEDX] In Search of a Common Definition of Dx Error
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto: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 <tel:%28504%29%20256-8797>
>> Email ruthryan at cox.net <mailto:ruthryan at cox.net>
>> <image001.jpg>
>>  
>>  
>> 
>> 
>> Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
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>> 
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>> 
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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 <tel:928%20203-4517>
> 
> 
> 
> 
> 
> Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> 
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/ <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









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


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