[IMPROVEDX] variations in variability

Tom Benzoni benzonit at GMAIL.COM
Fri Dec 2 12:45:50 UTC 2016


EditorialsStatins for primary prevention of cardiovascular diseaseBMJ 2016;
355 doi: http://dx.doi.org/10.1136/bmj.i6334 (Published 24 November 2016)Cite
this as: BMJ 2016;355:i6334Patients need better tools to navigate divergent
recommendations

So who is right?

If my gaze is diverges as I drive, only one of the yellow stripes is the
road.Which do I follow?
Sorting out this question would be a good task for the brain trust on this
list.
tom

On Fri, Nov 4, 2016 at 12:09 PM, Grefe, Rosemary <
RGrefe at childrensnational.org> wrote:

> Hi,
>
>
>
> These are all good points.  Unfortunately, we have been using many of our
> diagnostic tools in an inconsistent manner, then claiming the data isn’t
> reliable.  Many countries that are part of the GLI have gone as far as
> having system wide training requirements where tests and demonstrations are
> part of the exam.
>
>
>
> There is always a financial consideration to anything we do in our
> healthcare system.  I think the study is trying to demonstrate that we are
> actually causing an increase in cost due to incorrect diagnosis and
> treatment by not following the national guidelines currently in place.
>
>
>
> Also, what about the CLIA exclusions?
>
>
>
> Thank you,
>
>
>
> Rosemary
>
>
>
> *From:* Kodolitsch von, Yskert [mailto:kodolitsch at uke.de]
> *Sent:* Friday, November 04, 2016 12:54 PM
> *To:* Society to Improve Diagnosis in Medicine; Grefe, Rosemary
> *Subject:* AW: [IMPROVEDX] [IMPROVEDX] variations in variability
>
>
>
> Hi,
>
>
>
> I think that question addresses the level of medical evidence. Whenever
> you want to change clinical management you need data to show that this is
> reasonable. If you extend pulmonary function testing to large groups of
> patients you need to show that this is justified. A clear question can be
> addressed with a well-defined study that may result in improved guidelines.
> So I think everything is fine up to this point.
>
>
>
> But then there is a big discussion about guideline adherence. Do
> physicians adhere to guidelines? What a reasons for not adhering to
> guidelines? What are the economic consequences of modified guideline
> recommendations? Is the evidence strong enough to justify a strict level I
> recommendation, and so on. Therefore, again we enter the field of complex
> systems … as stated.
>
> J
>
> Best
>
>
>
> Yskert
>
>
>
>
>
> *Von:* Grefe, Rosemary [mailto:RGrefe at CHILDRENSNATIONAL.ORG
> <RGrefe at CHILDRENSNATIONAL.ORG>]
> *Gesendet:* Freitag, 4. November 2016 16:28
> *An:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Betreff:* Re: [IMPROVEDX] [IMPROVEDX] variations in variability
>
>
>
> Hi,
>
>
>
> I am a respiratory therapist responsible for managing pulmonary diagnostic
> services in our system.  I have often wondered why only radiology and
> medical labs services were put under CLIA.  I contacted them to find out
> but did not receive an answer.  The premise for the creation of CLIA was to
> avoid adverse complications due to incorrectly collected or reported
> diagnostic information.  The reasoning that I have been given in
> conversation for the limitations on its scope have been that there is no
> negative consequences when diagnostic data collected in areas other than
> radiology and med lab are collected incorrectly or reported incorrectly.
>
>
>
> I have attached an announcement that came out in one of my professional
> magazines that reports a grant that has been awarded to determine how to
> improve on the misdiagnosis of patients with asthma or COPD due to lack of
> correct diagnostic testing or any testing at all.  The amount of patients
> is staggering and the percentage of incorrect diagnoses  troubling.  If we
> add in the pediatric population and other diseases I can only imagine the
> impact of this problem.
>
>
>
> What do you think about the inconsistency in oversight of all diagnostic
> work?   This would include cardiology, neurology, and any other specialty
> that relies heavily on different types of data collection but is not
> required to meet any national standards.
>
>
>
> I look forward to your response,
>
>
>
>
>
> Rosemary Grefe RRT RPFT BS
>
> Manager, Pulmonary Diagnostics
>
> 202.476.4163 <(202)%20476-4163>
>
> rgrefe at cnmc.org
>
> 111 Michigan Ave. NW
>
> Suite 1030
>
> Childrens National Medical Center
>
> Washington, DC 20010
>
>
>
>
>
>
>
> *From:* Hess, Dr. Donald [mailto:dhess at SUSQUEHANNAHEALTH.ORG
> <dhess at SUSQUEHANNAHEALTH.ORG>]
> *Sent:* Friday, November 04, 2016 6:36 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] [IMPROVEDX] variations in variability
>
>
>
> Hello Yskert:
>
>
>
> What are the reasons that the medical profession is structurally unable to
> catch-up with its own professional ideals?
>
>
>
> Regards,
>
>
>
> Dr. Donald Hess
>
>
>
> *From:* Kodolitsch von, Yskert [mailto:kodolitsch at UKE.DE
> <kodolitsch at UKE.DE>]
> *Sent:* Thursday, November 03, 2016 4:15 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] AW: [IMPROVEDX] [IMPROVEDX] variations in
> variability
>
>
>
> Dear Rob,
>
>
>
> Yes, clearly you aim primarily at avoiding diagnostic errors.
>
> But, I am trying to promote a view that fighting diagnostic error should
> be embedded in a couple of issues that go far beyond the narrow description
> of the problem itself.
>
> The human cognition is always involved, but human communication, human
> motivation, team collaboration, labor environment, information
> technologies, and so on are also involved. To approach this, we need some
> kind of concept about how to address this system.
>
> So, to reduce diagnostic error, we need people to get involved in really
> doing something about the problem:
>
> You need to think about hospital (or other health) organizations. You need
> to address human behavior, not just of physicians, but also nurses,
> managers, transports, lab people, and so on. You need to think about
> leadership. Who is leader in a hospital. What do you ground leadership on.
> How important is it to leaders to promote patient safety, and so on. You
> may read the classic by Elliot Freidson, who explained in his seminal
> analysis of the organization of the medical profession, why the medical
> profession in his times (the book was published in 1970) was “structurally”
> unable to catch-up with its own professional ideals (see:
> http://press.uchicago.edu/ucp/books/book/chicago/P/bo3634980.html
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__press.uchicago.edu_ucp_books_book_chicago_P_bo3634980.html&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=Y0C8iH00jgms7w4Md22o6IJZXRc2QB7El9MwdRAZ_og&s=fI3kThAJVksBwRCYu6Yj50HD06QDcemjXANkY0xJvSI&e=>
> ). These issues are essential, I am deeply convinced.
>
>
>
> Clearly, one can try to isolate the problem, and stick to “error” in a
> narrow sense. Clearly: Check-lists, IT-based solutions, supervision,
> checking-routines, and so on do have a definitive value. But these “narrow
> measures” will also not yield ground-braking results if not embedded in a
> commensurate organizational culture that respects the safety of patients.
> And again we are back to the organizational system, leadership, strategy.
> We do not come around a discussion of broader approaches. …
>
> … I firmly believe … this may not be evidence-based (though Freidson
> indeed carried together impressive data to support this view).
>
>
>
> You said that you thought that “making the right diagnosis was ethical
> within itself”. I do not think so. Making a correct diagnosis does not seem
> ethical as such. Only if it severs ethical purposes (which is usually but
> not necessarily does: The Nazi-medicine, for example, did this for criminal
> purposes). A correct diagnosis used as means to help a patient is ethical;
> striving vigorously and uncompromisingly to get to a correct diagnosis is
> ethical when motivated to help a patient; engaging in getting people to
> think about getting to better diagnostic results (like you do) is ethical,
> if you do this with the motivation of help patients, but it may also not be
> ethical in those who do it to increase their own prestige. Therefore,
> cultivating virtue among physicians in a hospital rather than cultivating
> prestige and money is important. Imagine a career-orientated physician, who
> only strives for avoiding diagnostic error to impress his boss rather than
> to help his patient. What will he do, when he is sure that sloppy work
> remains undiscovered by his superiors? …
>
>
>
> We need a broader view of the problem. I insist.
>
> J
>
>
>
> Best,
>
> Yskert
>
>
>
>
>
>
>
> *Von:* robert bell [mailto:rmsbell200 at yahoo.com <rmsbell200 at yahoo.com>]
> *Gesendet:* Mittwoch, 2. November 2016 18:40
> *An:* Kodolitsch von, Yskert <kodolitsch at uke.de>
> *Cc:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Betreff:* Re: [IMPROVEDX] [IMPROVEDX] variations in variability
>
>
>
> Thanks Yskert,
>
>
>
> Not quite sure about the question. I would go with “What are the best ways
> to help our colleagues make less errors in diagnosis.”
>
>
>
> As an aside I would have thought that making the right diagnosis was
> ethical within itself.
>
>
>
> Once we have clarified what we think are the best ways we can start making
> progress and doing something. And if  we do not get it right the first time
> we can change things.
>
>
>
> And the "best ways” would include a discussion of conflicts. disclaimers,
> and litigation issues.
>
>
>
> Will take a look at your link - thanks for sending.
>
>
>
> Rob
>
> On Nov 2, 2016, at 9:04 AM, Kodolitsch von, Yskert <kodolitsch at uke.de>
> wrote:
>
>
>
> I understand your question in essence as the following: “How can we make
> people act in a desirable way?”
>
> Or: How can we make people go from “is to ought” (David Hume), which may
> also be formulated as the question “how can we put ethical demands into
> medical practice?”
>
>
>
>
> ------------------------------
>
> Universitätsklinikum Hamburg-Eppendorf; Körperschaft des öffentlichen
> Rechts; Gerichtsstand: Hamburg | www.uke.de
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.uke.de&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=Y0C8iH00jgms7w4Md22o6IJZXRc2QB7El9MwdRAZ_og&s=eHs2dgXV8Y9zrwyVsP90FnxmaL8flEcz8U4K7EKDor8&e=>
> Vorstandsmitglieder: Prof. Dr. Burkhard Göke (Vorsitzender), Prof. Dr. Dr.
> Uwe Koch-Gromus, Joachim Prölß, Rainer Schoppik
> ------------------------------
>
> SAVE PAPER - THINK BEFORE PRINTING
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FSUBED1-3DIMPROVEDX-26A-3D1&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=Y0C8iH00jgms7w4Md22o6IJZXRc2QB7El9MwdRAZ_og&s=K3ZPp8ulnPDL-8ct8ij9FEe5bB3Fb4NFWeLsB7a4JMU&e=>
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FINDEX&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=Y0C8iH00jgms7w4Md22o6IJZXRc2QB7El9MwdRAZ_og&s=L9ntvn7CBwwvPnDH_eJ8HSfD_BRDBLGMsMVp_PpnQa0&e=>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=Y0C8iH00jgms7w4Md22o6IJZXRc2QB7El9MwdRAZ_og&s=-9HutfkY-K7nMaQuPWtr397dCfu-97OM-PP-aRsTld4&e=>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FSUBED1-3DIMPROVEDX-26A-3D1&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=Y0C8iH00jgms7w4Md22o6IJZXRc2QB7El9MwdRAZ_og&s=K3ZPp8ulnPDL-8ct8ij9FEe5bB3Fb4NFWeLsB7a4JMU&e=>
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FINDEX&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=wfRTVAtNmdpGUObv8-s_pBnm5QBlr8vjUR_qArt3yjo&m=42qwwp7BYDs5Yzalfx02_l82cYlBvFGvOgeMM6c5BOo&s=EhUiRMsxLOvAZiASzlYQ5YUbdAC4HZqFUoBXC-tNZQc&e=>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=wfRTVAtNmdpGUObv8-s_pBnm5QBlr8vjUR_qArt3yjo&m=42qwwp7BYDs5Yzalfx02_l82cYlBvFGvOgeMM6c5BOo&s=koxiza9Aze7GZV1K9-LVIdK0PuEv0mMvNHsKUlpMG7Y&e=>
> ------------------------------
>
> Confidentiality Notice: This e-mail message, including any attachments, is
> for the sole use of the intended recipient(s) and may contain confidential
> and privileged information. Any unauthorized review, use, disclosure or
> distribution is prohibited. If you are not the intended recipient, please
> contact the sender by reply e-mail and destroy all copies of the original
> message.
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FSUBED1-3DIMPROVEDX-26A-3D1&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=wfRTVAtNmdpGUObv8-s_pBnm5QBlr8vjUR_qArt3yjo&m=42qwwp7BYDs5Yzalfx02_l82cYlBvFGvOgeMM6c5BOo&s=0XjFGbKOSXfJGcEh2Ou6-Z9fHIs9XjyjfI9KLzwbFd8&e=>
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FINDEX&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=wfRTVAtNmdpGUObv8-s_pBnm5QBlr8vjUR_qArt3yjo&m=42qwwp7BYDs5Yzalfx02_l82cYlBvFGvOgeMM6c5BOo&s=EhUiRMsxLOvAZiASzlYQ5YUbdAC4HZqFUoBXC-tNZQc&e=>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=wfRTVAtNmdpGUObv8-s_pBnm5QBlr8vjUR_qArt3yjo&m=42qwwp7BYDs5Yzalfx02_l82cYlBvFGvOgeMM6c5BOo&s=koxiza9Aze7GZV1K9-LVIdK0PuEv0mMvNHsKUlpMG7Y&e=>
>
>
> ------------------------------
>
> Universitätsklinikum Hamburg-Eppendorf; Körperschaft des öffentlichen
> Rechts; Gerichtsstand: Hamburg | www.uke.de
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.uke.de&d=DQMGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=wfRTVAtNmdpGUObv8-s_pBnm5QBlr8vjUR_qArt3yjo&m=42qwwp7BYDs5Yzalfx02_l82cYlBvFGvOgeMM6c5BOo&s=5o0lMPppTGKwW8y9_Vnmlc_99oNhc8M1HZmG9_ykBqs&e=>
> Vorstandsmitglieder: Prof. Dr. Burkhard Göke (Vorsitzender), Prof. Dr. Dr.
> Uwe Koch-Gromus, Joachim Prölß, Rainer Schoppik
> ------------------------------
>
> SAVE PAPER - THINK BEFORE PRINTING
> ------------------------------
> Confidentiality Notice: This e-mail message, including any attachments, is
> for the sole use of the intended recipient(s) and may contain confidential
> and privileged information. Any unauthorized review, use, disclosure or
> distribution is prohibited. If you are not the intended recipient, please
> contact the sender by reply e-mail and destroy all copies of the original
> message.
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST@
> LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>






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


HTML Version:
URL: <../attachments/20161202/03e3106b/attachment.html>


More information about the Test mailing list