Fwd: 'Contextual Errors' Costly, but Not Being Measured

Shojania, Dr. Kaveh Kaveh.Shojania at SUNNYBROOK.CA
Wed May 11 19:35:08 UTC 2016


That group does indeed do good work.

FYi, they published a follow up paper (from the Annals one) with us at BMJ  Qual Saf this year. Providers contextualise care more often when they discover patient context by asking: meta-analysis of three primary data sets

http://qualitysafety.bmj.com/content/25/3/159.full?sid=68c4af69-6aac-4baa-89e0-7d327eb1cbad

Analyzing 3 different data sets (one being the one from the Annals paper the Medscape article mentions), they showed that docs acted on social context issues (eg, food insecurity or job loss) when coming up with a care plan arm more often if the docs had inquired about possible problems as opposed to the patient spontaneously bringing it up.

When we were reviewing the paper and sending minor revisions requests to the authors, I mentioned that the result reminded me a little of a paper from the medical decision making lit in which Don Redelemeier and colleagues showed that clinicians assign more weight to information that they have to work to obtain - e.g, in forming a diff diagnosis. [Redelmeier DA, Shafir E, Aujla PS. The beguiling pursuit of more information. Med Decis Making 2001;21:376-81. ]

It was a minor point and I didn't tell the authors they had to reference it, but the first author apparently knew of the paper already and happily added to the discussion.
The Redelmeier study is more an example of a cog bias of the type people like to think about in the context of Dx errors. The problem about not paying as much attention to important assertions by patients that are made spontaneously instead of in reply to questions obviously adds other regrettable elements ;)

-kgs

Kaveh G. Shojania, MD
Professor and Vice Chair, Quality & Innovation
Department of Medicine, University of Toronto
Director, Centre for Quality Improvement and Patient Safety (C-QuIPS)
http://www.cquips.ca/

Editor-in-Chief,
BMJ Quality & Safety

Sunnybrook Health Sciences Centre
Room H468, 2075 Bayview Avenue
Toronto, Ontario M4N 3M5
Phone: 416-480-6100 x 89608
Fax: 416-480-6777
Email kaveh.shojania at sunnybrook.ca<mailto:kaveh.shojania at utoronto.ca>

From: David L Meyers [mailto:dm0015 at COMCAST.NET]
Sent: Wednesday, May 11, 2016 2:10 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Fwd: 'Contextual Errors' Costly, but Not Being Measured

A link to an interesting news story on Medscape, reporting on material presented at a recent ACP conference.

http://www.medscape.com/viewarticle/863033?src=rss

David
David L Meyers, MD FACEP
Listserv Moderator/Board member
Society to Improve Diagnosis in Medicine
Save the Date: Diagnostic Error in Medicine, November 6-8, 2016, Los Angeles, CA
Save the Date: DEM-Europe, June30-July 1, 2016, Rotterdam, The Netherlands






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