Boston Globe Medical Mystery

James Sorace jamessorace1 at GMAIL.COM
Tue Dec 19 16:53:01 UTC 2017


Melanie - perhaps we could brainstorm on these issues (possibly work on a
paper)? I am a pathologist with a HIT bavkground n the Baltimore area and l
am interested in SIDM.

On Dec 17, 2017 9:41 PM, "Powell, Melanie A" <Melanie.A.Powell at medstar.net>
wrote:

> Ed - I'm glad you brought this up. I am a member of my hospital's Patient
> and Family Advisory Council for Quality and Safety and one of our very
> active members sent a similar article to our group this morning (re: cancer
> diagnosis in a young adult who was told she was too young to have the
> diagnosis).
>
> It would be very interesting to do a study (retrospective or prospective)
> asking patients if they raised a concern to their provider about an
> alternate diagnosis and whether this concern was heeded, then perform chart
> review to see if physicians who heed patient concerns: 1) refer for second
> opinion or 2) broaden their differential (in whatever form) diagnose more
> accurately and faster. [If this study has been done - please share!]
>
> We've discussed the challenge of balancing diagnostic accuracy vs.
> diagnostic stewardship. We've also discussed the challenge of bias and
> heuristics on the cognitive process. Ed - while you were able to
> successfully guess the diagnosis, as you mention you had the slight
> advantage of knowing it was an obscure disease. How do we create these
> flags for ourselves (in the EHR or via CDS tools) to bolster the cognitive
> process so we don't have to rely on hindsight to learn how we might have
> gotten to the correct diagnosis?
>
> At the DEM conference in October, Kaiser Permanente Southern
> California group mentioned an EHR (Epic) based "second opinion" messaging
> service to specialists from PCPs for urgent or routine feedback. I wonder
> how many of these programs exist, at what rate these consults result in a
> confirmed or new diagnosis, and whether merely having the option of a
> reliable second opinion broadens a physician's differential. It would also
> be interesting to routinely perform "second opinion chart audits" to
> determine the rate of near miss diagnostic error events (i.e. delayed or
> missed diagnosis that was caught via chart audit prior to patient harm).
> Does anyone know of a study like this (being undertaken or previously
> published)?
>
> Melanie Powell, MD/MPH
> Fellow, MedStar Institute for Quality and Safety
> (c) 410-688-5216 <(410)%20688-5216>
> Website: http://www.medstariqs.org/
>
> ------------------------------
> *From:* Edward Hoffer [ehoffer at GMAIL.COM]
> *Sent:* Sunday, December 17, 2017 3:49 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] Boston Globe Medical Mystery
>
> Today's Boston Globe had a special magazine on medical issues. Lead story,
> on P2, is a dramatic story of a young man whose debilitating illness took 8
> years to be diagnosed. Clued strongly by the fact that this was an obscure
> disease, I guessed it after reading the first paragraph. More importantly,
> putting the symptoms from the first paragraph and one from the third into
> both DXplain and Isabel gave the diagnosis (#1 on DXplain list, #7 and
> red-flagged on Isabel's)
> When will such "second opinions" become mandatory?
> Ed
> Edward P Hoffer MD, FACP, FACC
>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
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> To learn more about SIDM visit:
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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