Uncertainty

Wong, John jwong at TUFTSMEDICALCENTER.ORG
Tue Jun 20 20:50:15 UTC 2017


Regarding malpractice and informed consent, there are 2 existing standards. Per King, Jaime Staples, Moulton, Benjamin. Rethinking Informed Consent: The Case for Shared Medical Decision-Making. American Journal of Law & Medicine, 32 (2006): 429-501.

“Currently, the states are almost evenly split between two types of standards for informed consent – the physician-based standard, effective in 25 states, and the patient-based standard, effective in 23 states and the District of Columbia. Physician-based standards generally require physicians to inform a patient of the risks, benefits and alternatives to a treatment in the same manner that a ’reasonably prudent practitioner’ in the field would. On the other hand, patient-based standards hold physicians responsible for providing patients with all information on the risks, benefits and alternatives to a treatment that a ‘reasonable patient’ would attach significance to in making a treatment decision.”

And in two of their closing paragraphs, they create a vision of informed consent 2.0:

“A substantial overhaul of the current informed consent system is needed to balance the patient autonomy with physician expertise and beneficence. Rather than pitting patients and physicians against one another, requiring patients to have blind faith in their physicians, or requiring physicians to only provide statistical information but not their professional opinion, an informed consent standard that encourages open communication, shares input and responsibility between physician and patient, and reestablishes the physician patient relationship should be instituted. Shared decision-making can accomplish these goals. . . . we believe that in the long run the benefits of shared decision-making and the use of evidence-based decision aids far outweigh the costs. Such a system would provide patients and physicians with: clarity of the information required for disclosure; ease with which to retrieve it, update it and supplement it; and the resources necessary to inform patients of the relevant options without  significantly draining physician resources. Patients would experience more autonomy in their medical decisions and more opportunity to consider their own value systems in their treatment options. Physicians will no longer have to guess regarding their legal liability and they can generally improve the health outcomes of their patients by enabling them to be more invested in the treatment choice.”

From: HM Epstein [mailto:hmepstein at GMAIL.COM]
Sent: Tuesday, June 20, 2017 12:34 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Uncertainty

Is the legal standard used for malpractice lawsuits the same standard that is currently being taught in medical schools and is that the standard that is practiced by most HCP's? Are there any studies looking at the prevalence of use of heuristics vs. differential diagnosis in outpatient care?


Best,
Helene

Sent from my iPhone

On Jun 20, 2017, at 11:52 AM, Phillip Benton <0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> wrote:

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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