Definition of Diagnosis Error

Tom Benzoni benzonit at GMAIL.COM
Sun Feb 5 21:17:42 UTC 2017


To add a 3rd dimension and using the issues discussed, believing in a
treatment doesn't make it work.
TPA is a case in point; we'd like to have a treatment for stroke symptoms
so we apply old cardiac logic.
(I remember streptokinase, too.)
Note how mechanical thrombectomy appears to be better than TPA.
Thus, if you apply a treatment that doesn't work but is currently believed
to work (and we have myriad examples of these,) is that an error?
Is it an error to follow guidelines that are accepted but are wrong?
(Remember giving 30 mg/kg methylpred for spinal injuries? CDC and other
august bodies promulgated guidelines extolling this.)
tom

On Sun, Feb 5, 2017 at 12:29 PM, Kohn, Michael <Michael.Kohn at ucsf.edu>
wrote:

> Dear Colleagues,
>
> As per my prior post, I see two types of diagnostic error: 1) failing to
> provide effective treatment for something the patient has, and 2) treating
> unnecessarily for something the patient doesn't have.  If you believe tPA
> is effective treatment for acute stroke, then failing to provide it to a
> patient with a stroke is the first type of error, and providing it to a
> patient with a stroke mimic, such as a complicated migraine, is the second
> type of error.  Overdiagnosis is the second type of error.  Giving the
> wrong treatment combines (1) failing to treat with (2) treating
> unnecessarily.
>
> One correspondent correctly pointed out that these are actually treatment
> errors.  I am focused on incorrect decisions, not incorrect naming of a
> patient's illness.  With my narrower view, failing to apply the correct
> name to a benign, self-limited condition is not an error so long as you
> don't provide unnecessary and harmful treatment.  Also, failing to
> distinguish between two illnesses with the same effective treatment is not
> an error unless you fail to provide that treatment.  I am not one of those
> physicians who tries to please patients by applying a Greek name to their
> benign problem (cephalgia for headache), but this isn't necessarily an
> error.  Failing to identify an aneurysmal subarachnoid hemorrhage is an
> error because prompt referral for coiling can save the patient's life.
>
> One other point: all of this refers to patients who have symptoms, i.e.,
> they feel sick.  Screening of patients with no known symptoms of disease is
> a different matter.  That is primarily though not exclusively what H.
> Gilbert Welch was referring to in "Overdiagnosed: Making People Sick in the
> Pursuit of Health".
>
> Respectfully,
>
> Michael
>
> Michael A. Kohn, MD, MPP
>
>
> Chairman, Emergency Department
>
> Mills-Peninsula Medical Center
>
>
> Associate Professor
>
> UCSF Epidemiology and Biostatistics
>
> (Email created using voice recognition.  Please excuse transcription
> errors.)
> ------------------------------
> *From:* Joe Graedon [jgraedon at GMAIL.COM]
> *Sent:* Sunday, February 05, 2017 5:32 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Definition of Diagnosis Error
>
> Bob,
>
> I think the IOM definition is comprehensive and helpful.
>
> Joe
>
> Sent from my iPad
>
> On Jan 18, 2017, at 8:54 AM, Bob Latino <blatino at RELIABILITY.COM> wrote:
>
> Is over-diagnosis considered a diagnostic error?
>
>
>
> *Robert J. Latino, CEO*
>
> Reliability Center, Inc.
>
> 1.800.457.0645 <(800)%20457-0645>
>
> blatino at reliability.com
>
> www.reliability.com
>
> <image001.jpg>
> <https://www.linkedin.com/company/958495?trk=tyah&trkInfo=clickedVertical%3Acompany%2CclickedEntityId%3A958495%2Cidx%3A1-1-1%2CtarId%3A1464096807851%2Ctas%3Areliability%20center%2C%20inc.>
>
>
>
> *From:* Bob Latino [mailto:blatino at RELIABILITY.COM
> <blatino at RELIABILITY.COM>]
> *Sent:* Wednesday, January 18, 2017 6:23 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] Definition of Diagnosis Error
>
>
>
> Is this IOM Definition of Diagnosis Error an accepted definition by SIDM?
>
>
> What is Diagnostic Error?
>
> The Institute of Medicine recently defined diagnostic error as the failure
> to (a) establish an accurate and timely explanation of the patient’s health
> problem(s) or (b) communicate that explanation to the patient. Simply put,
> these are diagnoses that are missed altogether, wrong, or should have been
> made much earlier.
>
> These categories overlap, but examples help illustrate some differences:
>
> *A missed diagnosis *refers to a patient whose medical complaints are
> never explained. Many patients with chronic fatigue, or chronic pain fall
> into this category, as well as patients with more specific complaints that
> are never accurately diagnosed.
>
> *A wrong diagnosis* occurs, for example, if a patient truly having a
> heart attack is told their pain is from acid indigestion. The original
> diagnosis is found to be incorrect because the true cause is discovered
> later.
>
> *A delayed diagnosis* refers to a case where the diagnosis should have
> been made earlier. Delayed diagnosis of cancer is by far the leading entity
> in this category. A major problem in this regard is that there are very few
> good guidelines on making a timely diagnosis, and many illnesses aren’t
> suspected until symptoms persist, or worsen.
>
>
>
>
>
> *Robert J. Latino, CEO*
>
> Reliability Center, Inc.
>
> 1.800.457.0645 <(800)%20457-0645>
>
> blatino at reliability.com
>
> www.reliability.com
>
> <image001.jpg>
> <https://www.linkedin.com/company/958495?trk=tyah&trkInfo=clickedVertical%3Acompany%2CclickedEntityId%3A958495%2Cidx%3A1-1-1%2CtarId%3A1464096807851%2Ctas%3Areliability%20center%2C%20inc.>
>
>
> ------------------------------
>
>
>
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
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>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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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/
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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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/
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> 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


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