An illustration of the method of diagnosis in practice.

Bob Latino blatino at RELIABILITY.COM
Tue Jan 2 14:01:12 UTC 2018

Thank you Dr. Bimal

For the non-clinicians (like me), what would be the 'normal' approach to diagnosing this patient?

When we investigate undesirable outcomes in industry and healthcare, the investigation is initiated based on the facts (the evidence presented at the scene), which then has to be explained.  Therefore the questioning begins of 'How Could' the facts presented, have come to be?

This requires hypotheses to be generated as to potential possibilities.  Tests then have to be conducted to determine which of the hypotheses (noting that one or more could be at play) are proven to be true or not true. Those that are proven to be true, are subjected to continuing questioning to drill deeper into understanding the human decisions and their systemic/sociotechnical contributors to the undesirable outcome.

Of course in these cases (investigations), we are reconstructing a sequence of events that did not turn out as planned, so there ends up being a negative consequence that has to be dealt with.

This discussion is different in the sense that you are trying to make an initial, accurate diagnosis in a timely manner.  However, if the initial diagnosis is wrong, it is only a step or two away from potentially being an undesirable event with diagnosis error being one of the contributing factors.  Then an investigation starts and these same issues are explored in hindsight.

I'm just trying to  learn the baseline norm for making a diagnosis so I can compare to what you are proposing (that I suspect is being presented as 'different').  What you propose in quite familiar and our 'norm' already, so that is why I am asking.

Thanks for your patience with my questions.

Robert J. Latino, CEO
Reliability Center, Inc.
blatino at
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From: Jain, Bimal P.,M.D. [mailto:BJAIN at PARTNERS.ORG]
Sent: Tuesday, January 02, 2018 8:15 AM
Subject: [IMPROVEDX] An illustration of the method of diagnosis in practice.

In this attached paper, I illustrate the method of diagnosis in practice by discussing diagnosis in a patient.
Please review and comment on this paper.


Bimal P Jain MD
Northshore Medical Center
Lynn MA01904

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