Dx Error: strep turns out to be 'necrotizing fasciitis'

Tom Benzoni benzonit at GMAIL.COM
Mon Apr 10 02:22:05 UTC 2017


It looks like it was initially considered and diagnosed, according to this
story.
tom

On Sun, Apr 9, 2017 at 6:35 PM, Bob Latino <blatino at reliability.com> wrote:

> Is this a case where 'necrotizing fasciitis' is so rare it would not have
> been initially considered?  Should it have initially considered?
>
> http://ijr.com/2017/04/841212-6-year-old-complained-sore-
> throat-infection-spread-doctors-remove-leg/?utm_
> source=Facebook&utm_medium=Owned&utm_term=ijamerica&utm_
> campaign=ods&utm_content=Family
>
> Sent from my iPhone
>
> On Apr 9, 2017, at 7:20 PM, Bob Swerlick <rswerli at GMAIL.COM> wrote:
>
> We have a single payer system closer to home, that being the VA health
> system. I do not know of any data suggesting that the frequency of
> diagnostic error is any better or worse within the VA. I also cannot think
> of any reason why a single payer system would be better at diagnostic work.
> Perhaps someone who suggested this could provide me with their train of
> thought?
>
> Bob Swerlick
>
> On Sun, Apr 9, 2017 at 4:33 PM, Peggy Zuckerman <peggyzuckerman at gmail.com>
> wrote:
>
>> Re the question if a country with a single-payer system automatically
>> grants patients better care and better outcomes, the real question to be
>> posed is what measures are used to do so.
>>
>> In my kidney cancer world which encompasses many patients in the US,
>> Canada and the UK, I know of many errors in diagnosis in each of them.
>> Much of those errors derive from the simple lack of expertise by a mix of
>> doctors. Primary care docs don't consider the symptoms which can be
>> reported over a long period of time, whether serious back aches (flank pain
>> is classic symptom--but what patient uses the term "flank pain"?), anemia,
>> or unexplained weight loss. Urologists who may operate to remove a tumor
>> often do not complete the diagnosis with CTs and /or bone scans, and
>> reassure the patient, "I got it all", yet they do not search out the
>> non-localized metastases.  When that patient finally is sent to an
>> oncologist, if ever, the oncologist may not have any idea of what to do,
>> and may simply apply the 25 year old treatment--nothing--or use the latest
>> newly approved drug, but with little understanding of the disease and those
>> treatments.
>>
>> All of these mistakes happen in all three of these countries.  In Canada,
>> the province in which one lives makes a difference as to the medicines
>> and/ior specialists available. Similar in the UK, with Scotland having far
>> higher death rates from cancer.  The measures of treatment for diagnosed
>> cancer patients is mandated to start at 31 days.  Yet extending out tests
>> which diagnose, including those which should have been done simultaneously
>> gives a reset of the clock.  So treatment does not begin in 31 days, but 31
>> days after 90 days of delayed testing.
>>
>> Peggy z
>>
>> Peggy Zuckerman
>> www.peggyRCC.com
>>
>> On Sun, Apr 9, 2017 at 8:34 AM, Goldman, Bruce I <
>> Bruce_Goldman at urmc.rochester.edu> wrote:
>>
>>> Lab accreditation is supposed to assure autopsy quality, but diagnostic
>>> accuracy is not a directly evaluated parameter-it is a really important
>>> question, especially since the primary responsibility for an autopsy is
>>> often given to a trainee.
>>>
>>> -----Original Message-----
>>> From: Traian Mihaescu [mailto:traian at MIHAESCU.EU]
>>> Sent: Friday, April 07, 2017 3:08 PM
>>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>> Subject: Re: [IMPROVEDX] The Value of a Second Opinion at the Mayo Clinic
>>>
>>> "An autopsy can reveal clinically significant diagnoses missed before
>>> death"..but, are there any data about diagnostic errors in autopsy studies?
>>>
>>> Traian Mihaescu, MD
>>> Clinic of Pulmonary Diseases
>>> Iasi, Romania
>>> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ispr
>>> o.ro&d=DQIFaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&
>>> r=-7e4riqIt55t2dJrgCurSOAaZ9YfqnMopB2FIHXKJzY&m=SfdVEuqtJnQT
>>> I9F56tW2vYSsx863VpoqEHsQWBArk50&s=JH19pC8Ck33mexsqm9i2BBQPVI
>>> guU2vYL2CuhXd2xqY&e=
>>>
>>> > The gold standard used to be autopsy. Unfortunately, the rate too low
>>> > to be of much use today.
>>> >
>>> > Harry B. Burke, MD, PhD
>>> >
>>> > Chief, Section of Safety and Quality
>>> >
>>> >
>>> > Associate Professor of Medicine
>>> >
>>> > Department of Medicine
>>> >
>>> > F. Edward Hébert School of Medicine
>>> >
>>> > Uniformed Services University of the Health Sciences
>>> >
>>> >
>>> >> On Apr 5, 2017, at 12:45 PM, Mark Graber
>>> >> <Mark.Graber at IMPROVEDIAGNOSIS.ORG> wrote:
>>> >>
>>> >> Thanks Bridget for this KEY question.  There are indeed a few studies
>>> >> that have done longer-term follow up of patients to determine whether
>>> >> the second opinion was correct (referenced in the attached review
>>> >> article) and you won’t be surprised to know that in a fraction of
>>> >> these cases (around 10%) the original diagnosis was correct, or even
>>> >> something not yet considered.  These long-term follow-up studies are
>>> >> difficult to conduct but very valuable.
>>> >>
>>> >> Your comments also touch on another big problem in our field – what
>>> >> is the gold standard?  There is a great deal of uncertainty even at
>>> >> this level, given that biopsy and autopsy results are not always
>>> definitive.
>>> >>
>>> >> Mark
>>> >>
>>> >> Mark L Graber MD FACP
>>> >> President, SIDM
>>> >> Senior Fellow, RTI International
>>> >> Professor Emeritus, Stony Brook University
>>> >>
>>> >>
>>> >>
>>> >>
>>> >>
>>> >> From: Bridget Kane <kaneb at tcd.ie <mailto:kaneb at tcd.ie>>
>>> >> Date: Wednesday, April 5, 2017 at 12:49 AM
>>> >> To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>> >> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>,
>>> >> "mark.graber at improvediagnosis.org
>>> >> <mailto:mark.graber at improvediagnosis.org>"
>>> >> <Mark.Graber at Improvediagnosis.org>>
>>> >> <mailto:Mark.Graber at Improvediagnosis.org>>
>>> >> Subject: Re: [IMPROVEDX] The Value of a Second Opinion at the Mayo
>>> >> Clinic
>>> >>
>>> >> One of the questions for me is “are we assuming that the second
>>> >> opinion is the gold standard?”
>>> >> Or how can we identify the truth, i.e. the correct diagnosis?
>>> >>
>>> >> Is there a stronger placebo effect following a second opinion, I
>>> wonder?
>>> >>
>>> >> Does anyone have any research on this, by chance?
>>> >>
>>> >> Thanks
>>> >>
>>> >> Bridget
>>> >> On 4 Apr 2017, at 16:02, Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.
>>> ORG>> <mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG>> wrote:
>>> >>
>>> >> Just coming out – this study from the Mayo Clinic
>>> >> <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.washingtonp
>>> >> ost.com_national_health-2Dscience_20-2Dpercent-2Dof-2Dpatients-2Dwith
>>> >> -2Dserious-2Dconditions-2Dare-2Dfirst-2Dmisdiagnosed-2Dstudy-2Dsays_2
>>> >> 017_04_03_e386982a-2D189f-2D11e7-2D9887-2D1a5314b56a08-5Fstory.html-3
>>> >> Futm-5Fterm-3D.11d4a1346899&d=DQIFaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY
>>> >> 53YSKuLUQRxhA&r=-7e4riqIt55t2dJrgCurSOAaZ9YfqnMopB2FIHXKJzY&m=SfdVEuq
>>> >> tJnQTI9F56tW2vYSsx863VpoqEHsQWBArk50&s=A37cxdq81T3k3BLLvzRBM2uveYtXpG
>>> >> ll56AjR0LJ4Ns&e= > finds that 20% of referred patients end up with a
>>> very different diagnosis.  The findings are very similar to the results
>>> from the second opinion program at Best Doctors, as referenced in the Mayo
>>> Clinic article.  In both cases, however, these are not randomly selected
>>> patients being studied – they are patients who were concerned enough about
>>> their initial diagnosis (or lack thereof) to seek out the second opinion.
>>> >>
>>> >> Mark
>>> >>
>>> >> Mark L Graber MD FACP
>>> >> President, SIDM
>>> >> Senior Fellow, RTI International
>>> >> Professor Emeritus, Stony Brook University <image001.png>
>>> >>
>>> >>
>>> >>
>>> >> Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
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>>> 3NyDxDSKUsoR6QYIjHM06Qdv7t0j_14&e= " target="_blank">https://urldef
>>> ense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.
>>> org_scripts_wa-2DIMPDIAG.exe-3FSUBED1-3DIMPROVEDX-26A-3D1&d=
>>> DQIFaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=-7e4r
>>> iqIt55t2dJrgCurSOAaZ9YfqnMopB2FIHXKJzY&m=SfdVEuqtJnQTI9F56tW
>>> 2vYSsx863VpoqEHsQWBArk50&s=vQJq9jzUvRJP3NyDxDSKUsoR6QYIjHM06
>>> Qdv7t0j_14&e= </a>
>>> </p>
>>>
>>>
>>>
>>>
>>>
>>>
>>> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in
>>> Medicine
>>>
>>> To unsubscribe from the IMPROVEDX list, click the following link:<br>
>>> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.ex
>>> e?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.im
>>> provediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
>>> </p>
>>>
>>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBE
>> D1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST
>> .IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>
>
>
>
> --
> Bob Swerlick
>
> ------------------------------
>
>
> 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 at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> 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:
> 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


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