Paper published on Troponin testing

John Brush jebrush at ME.COM
Wed Nov 23 19:15:51 UTC 2016


I recently published an article entitled “Troponin Testing for Clinicians” in the Journal of the American College of Cardiology. Troponin testing is widely misunderstood and a source of diagnostic error. I wrote this paper to help improve the use of this important diagnostic test in an effort to improve diagnosis in medicine.
I hope you find this paper useful.
John

John E. Brush, Jr., M.D., FACC
Professor of Medicine
Eastern Virginia Medical School
Sentara Cardiology Specialists
844 Kempsville Road, Suite 204
Norfolk, VA 23502
757-261-0700
Cell: 757-477-1990
jebrush at me.com



On Nov 23, 2016, at 1:00 PM, Peggy Zuckerman <peggyzuckerman at GMAIL.COM> wrote:

I also read the complete article which did not explain fully exactly who made and/or failed to make the diagnosis of the patients.  Most people would assume that this kind of diagnosis needs an expert practitioner, and perhaps multiple visits and tests.  If there is no kind of patient-reported symptoms which are accepted into the record and captured, so that all those who might examine and treat the patient, this is an oversight.  

With the many problems that exist in electronic records, and with the special issues where there are psychological barrier to seeing the records, how do the vets get a review of their issue, know if they were properly diagnosed, etc?

And are seven months and one letter enough to find those in need?

Peggy

Peggy Zuckerman
www.peggyRCC.com <http://www.peggyrcc.com/>

On Wed, Nov 23, 2016 at 8:56 AM, HM Epstein <hmepstein at gmail.com <mailto:hmepstein at gmail.com>> wrote:
Hi Mark:

I would agree despite the headline if this paragraph wasn't part of the article:

"They were not conducted by properly qualified neurological and psychiatric specialists, resulting in not only potential misdiagnosis, but disability compensation claims that may have been unfairly denied."

As most on this listserv know, TBIs can be difficult to diagnose even for doctors who are trained to do so. That's why the potential new blood test has made headlines. But the VA are the ones who said the neurologists and psychiatrists were not properly qualified. 

Perhaps you can help me understand what was meant by "properly qualified". The Devil's in the details and this article is missing too many of them. 

Thank you, Mark. 

Best wishes for a Happy Thanksgiving,
Helene

-- 
hmepstein.com <http://hmepstein.com/> 
@hmepstein
Mobile: 914-522-2116 <tel:914-522-2116>

Sent from my iPhone



On Nov 23, 2016, at 11:05 AM, Mark Graber <mark.graber at improvediagnosis.org <mailto:mark.graber at improvediagnosis.org>> wrote:

Please excuse my bias as a VA provider, but the headline about misdiagnosis of TBI in combat veterans is probably highly misleading.  This is NOT a story about botched diagnoses.  The VA has been at the forefront of studying and trying to characterize and diagnose TBI since the war in Iraq.  This is a story about how much progress has been made in recognizing and understanding TBI over the past decades, transparency in admitting that the science of diagnosis in this field has advance considerably and trying to do the right thing for the affected patients (and being able to do so by tracking them through registries).  Its a story of how diagnosis improves, more than how it fails.

Mark

Mark L Graber MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook
President, Society to Improve Diagnosis in Medicine




On Nov 23, 2016, at 9:37 AM, HM Epstein <hmepstein at GMAIL.COM <mailto:hmepstein at GMAIL.COM>> wrote:

25 thousand veterans were just notified their traumatic brain injury was misdiagnosed. VA admits to 8 years of mishandling how the patients were diagnosed and treated. And then how their claims were rejected. 

This article is just about one city's numbers. 

http://www.wxyz.com/news/hundreds-of-local-vets-misdiagnosed-in-veterans-affairs-traumatic-brain-injury-exam-mishap <http://www.wxyz.com/news/hundreds-of-local-vets-misdiagnosed-in-veterans-affairs-traumatic-brain-injury-exam-mishap>

Best,
Helene
-- 
hmepstein.com <http://hmepstein.com/> 
@hmepstein
Mobile: 914-522-2116 <tel:914-522-2116>

Sent from my iPhone




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