Uncertainty

Xavier Prida dr.xavier.prida at GMAIL.COM
Tue Jun 20 23:23:04 UTC 2017


John,
That vision of "Informed Consent 2.0" precisly articulates the aim of
shared decision making embedded in the informed consent process- with both
the patient and the HCP equally invested in the outcome. Some would refer
to this as - relationship cantered care - with bi-directional education and
information exchange.

A recent AHA Scientific Statement , in part , addresses this educated
patient contribtion not so much in diagnosis, but management.

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​Xavier​




On Tue, Jun 20, 2017 at 4:50 PM, Wong, John <jwong at tuftsmedicalcenter.org>
wrote:

> 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> 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
>
>
> ------------------------------
>
> On Tuesday, June 20, 2017 robert bell <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>
> 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 <(813)%20259-0992>(O)
>
>
>
>
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-- 
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)






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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