Erroneous laboratory results

AVRUM GOLUB avrum_h_golub_md_jd at ME.COM
Fri May 27 17:28:29 UTC 2016


Colleagues:
One of the most useful, money-saving diagnostic technique we can use is that which we have learned and is located "between our ears" ... that is, if the legal profession allows us to do so.
Avrum 



Avrum Golub, M.D., J.D.
547 Asharoken Avenue
Asharoken, NY 11768-1121
Mobile: (631) 759-1930
avrum_h_golub_md_jd at me.com
ahg_md_jd at me.com


Dictated on my iPhone 

On May 27, 2016, at 8:44 AM, HM Epstein <hmepstein at GMAIL.COM <mailto:hmepstein at gmail.com>> wrote:

> Jason:
> Thank you for sharing that 2011 study. Not meaning to take this thread sideways but I noted that the senior resident was still misdiagnosing approximately 20% of the admitted patients and the hospitalist was misdiagnosing 15.6% of them even though both of them were taking a thorough history, doing clinical exams and ordering tests as needed. Is anyone surprised by those numbers or do they appear typical? 
> 
> Also, is there a way that we can mine other studies to better identify diagnostic error rates across the board? Most agree that the 5% annual Dx error rate from Hardeep Singh's ambulatory patient study that we've been using is rather low. Can we back into a more realistic number through a review of existing studies over a reasonable time period?
> Best,
> Helene
> 
> -- 
> hmepstein.com <http://hmepstein.com/> 
> @hmepstein
> Mobile: 914-522-2116
> 
> Sent from my iPhone
> 
> 
> 
> On May 27, 2016, at 5:54 AM, Jason Maude <jason.maude at ISABELHEALTHCARE.COM <mailto:jason.maude at isabelhealthcare.com>> wrote:
> 
> How is it the profession has ended up placing such reliance on an aspect which is shown to contribute so little and cost so much? 
> 
> This study backs up the old adage that 80% of the diagnosis is given by the history and physical with relatively little contributed by tests
> http://archinte.jamanetwork.com/article.aspx?articleid=1106285 <http://archinte.jamanetwork.com/article.aspx?articleid=1106285>
> 
> To paraphrase Churchill, never in an industry has so much been shown to contribute so little for so much expense!
> 
> Regards
> Jason Maude
> 
> 
> From: Tom Benzoni <benzonit at GMAIL.COM <mailto:benzonit at GMAIL.COM>>
> Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Tom Benzoni <benzonit at GMAIL.COM <mailto:benzonit at GMAIL.COM>>
> Date: Wednesday, 25 May 2016 17:08
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
> Subject: Re: [IMPROVEDX] Erroneous laboratory results
> 
> I'm a "thin" lab tester and 90% of what I order I don't need.
> My junior confreres order easily double my volume.
> Same outcomes narrowly defined; fully defined, worse outcomes.
> (I don't order d-dimer on patients without at least moderate likelihood PEs or DVT. My junior guys do so routinely and so do many more CTA and U/S. We have the same rate of final diagnoses. But I (likely) have fewer renal failures (we don't see followup) and fewer bankruptcies.
> 
> Take, for example, ABGs. They are rarely needed; the same data is available venously and from already done tests (BMP/MGA/SMA7), pulse ox and EtCO2, yet I see 40% of our ICU tests are ABG.
> CBC with diff when most folks can't interpret the diff but don't know they can't. CBC without diff when you only need the Hgb.
> EKG in my shop is an excellent predictor that you do NOT have ACS.
> All LPs go to IR.
> 
> I could go on. 
> 
> So overtesting is huge.
> 
> tom benzoni
> 
> On Wed, May 25, 2016 at 10:20 AM, Cameron Powell <cameron at physiciancognition.com <mailto:cameron at physiciancognition.com>> wrote:
> Perhaps some of you have already seen this study on under- and over-testing.
> 
> “First we found that the rate of overuse, meaning [medical laboratory] tests that we performed that shouldn’t have been performed, average around 20%. That means out of every 10 tests ordered about two tests on average should not have been ordered.
> 
> “Even more surprising was the rate of underuse [of medical laboratory tests]. This is the rate of tests that should have been ordered in a given time but weren’t ordered. That rate was over 40%. So, for every three tests performed, an additional two tests should have been ordered.”   
> 
> http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078962 <http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078962> 
> 
> 
> We’ve taken a run at solving suboptimal testing strategies and it’s going very well. We’ll keep you posted on our progress.
> 
> Cameron
> 
> 
> 
> Teaching Mode Is Here! (Android <https://play.google.com/store/apps/details?id=com.physiciancognition.xebrapro> | IOS <https://itunes.apple.com/us/app/xebra-pro/id1051676634>),
> 
> 
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>> On May 20, 2016, at 12:40 PM, DR WILLIAM CORCORAN <williamcorcoran at SBCGLOBAL.NET <mailto:williamcorcoran at sbcglobal.net>> wrote:
>> 
>> What do you think of the YouTube video and the comments posted?
>> 
>> WSJ journalist John Carreyrou shares year-long Theranos investigation & breaks latest, stunning news <https://youtu.be/zSgwJA-GOlg>
>>  
>>  
>>  <https://youtu.be/zSgwJA-GOlg>	
>>  
>>  
>>  
>>  
>>  
>> WSJ journalist John Carreyrou shares year-long Theranos ...
>>  <https://youtu.be/zSgwJA-GOlg>
>> View on youtu.be <https://youtu.be/zSgwJA-GOlg>	
>> Preview by Yahoo
>>  
>> 
>>  
>> Take care,
>>  
>> Bill Corcoran
>> 
>>  
>> William  R. Corcoran, Ph.D., P.E.
>> 21 Broadleaf Circle
>> Windsor, CT 06095-1634
>> 860-285-8779 <tel:860-285-8779>
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>> http://www.linkedin.com/in/williamcorcoranphdpe <http://www.linkedin.com/in/williamcorcoranphdpe>
>> https://www.box.com/shared/kfxg1lt9dh <https://www.box.com/shared/kfxg1lt9dh> 
>> 
>> 
>> 
>> On Friday, May 20, 2016 11:10 AM, Dwight Oxley <dwight.oxley at GMAIL.COM <mailto:dwight.oxley at gmail.com>> wrote:
>> 
>> 
>> The link below details how a large number of erroneous results were reported from a commercial medical laboratory. This report is just the latest in the Wall Street Journal’s coverage of the Theranos Co. Lab results account for more than 50% of the information in a medical record, thus the impact of these is enormous.
>> 
>> Dwight Oxley
>> 
>> 
>> http://on.wsj.com/1TpKiL3 <http://on.wsj.com/1TpKiL3>
>> 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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