Uncertainty

Grubenhoff, Joe Joe.Grubenhoff at CHILDRENSCOLORADO.ORG
Tue Jun 20 16:50:46 UTC 2017


That STAKES vs ODDS argument drives a lot of health care costs and those extra tests that cost so much have a FP/FN rate that leads us down rabbit holes and may expose patients to unnecessary risks and harms in their own right. A more accurate assessment is that the STAKES matter more when something bad happens and the ODDS matter more when the pocket book is concerned. Being a physician and trying to balance that is a tricky task. Essentially we’re asked to have a crystal ball.

We’ve had parents in our ER whose children have had significant blunt head trauma and have signs symptoms concerning for a serious intracranial injury so we order a head CT. When it comes back negative, they don’t want to pay the bill because it didn’t show anything so we should have somehow known not to get it.

One failure of the health care system is that we have separated the discussion of risk and cost for our patients. Many want everything ruled out but balk at the cost.

[Sig1]
Joe Grubenhoff, MD, MSCS| Associate Professor of Pediatrics
Section of Emergency Medicine | University of Colorado
Associate Medical Director - Clinical Effectiveness
Children's Hospital Colorado
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From: Phillip Benton [mailto:0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Sent: Tuesday, June 20, 2017 9:52 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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