Uncertainty

Follansbee, William follansbeewp at UPMC.EDU
Tue Jun 20 16:20:13 UTC 2017


Phillip,

Not trying to be cute, but that is why attorneys are not physicians. Under that premise, every patient with an upper respiratory infection and small infiltrate on a chest x-ray would be worked up for lung cancer.  Clearly that is not the way medical care can or should be done. As I am sure you agree, decisions on when it is appropriate to work up must not miss diagnoses are based on judgment, which is based upon both odds and stakes. Neither alone would result in quality medical care.

Best,

Bill

William P. Follansbee, M.D., FACC, FACP, FASNC
The Master Clinician Professor of Cardiovascular Medicine
Director, The UPMC Clinical Center for Medical Decision Making
Suite A429 UPMC Presbyterian
200 Lothrop Street
Pittsburgh, PA 15213
Phone: 412-647-3437
Fax: 412-647-3873
Email: follansbeewp at upmc.edu<mailto:follansbeewp at upmc.edu>

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From: Phillip Benton [mailto:0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Sent: Tuesday, June 20, 2017 11:52 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Uncertainty


Rob & Xavier,
The standard in patient/plaintiff's lawsuits is that when a physician is formulating a Diff Dx, the most dangerous Dx should be placed at the top and ruled out first. Stated simply, the STAKES matter far more than the ODDS.
Phillip  Benton, MD, JD
Adjunct Professor
Emoty Law School

Phillip Benton
pgbentonmd at aol.com<mailto:pgbentonmd at aol.com>

________________________________
On Tuesday, June 20, 2017 robert bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> wrote:
Xavier,

I would think not in a very scientific way. But it should be, and explained to the patient.

Doing a study with HCPs on their impression of the frequency of certain diseases/conditions in their practice and also in general practice would be interesting. The range I suspect would be eye opening.

A similar study on the length to diagnosis of rarer conditions would also be enlightening.

Should we not be able to get this information now from data bases?

Rob Bell MD.


On Jun 3, 2017, at 4:08 AM, Xavier Prida <dr.xavier.prida at GMAIL.COM<mailto:dr.xavier.prida at GMAIL.COM>> wrote:

Is uncertainty allowed for in the expectations of diagnosis and management?
Article;
Assumptions of Quality Medicine- The Role of Uncertainty
doi:10.1001/jamaoto.2017.0257

​Xavier​

Xavier E. Prida MD FACC FSCAI
Assistant Professor of Medicine
Program Director Cardiology Fellowship Training
USF Morsani College of Medicine
Department of Cardiovascular Sciences
2 Tampa General Circle
STC 5 th Floor
Tampa, Fl 33606
813 259 0992(O)


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