Tom Benzoni benzonit at GMAIL.COM
Fri Jan 5 15:35:25 UTC 2018

Front line thoughts, interdigitated:

On Thu, Jan 4, 2018 at 10:24 PM, robert bell <
0000000296e45ec4-dmarc-request at> wrote:

> Is there a problem in medicine regarding diagnoses and other errors in
> medicine when a patient gets transferred from one Physician/HCP to another,
> in or out of hospital?
> Some difficulties:
>    - One or more specialists are outside the computer system of the other.
> We have 2 major systems in town using 2 different systems. We communicate
by fax...which are hundreds of printed pages of indistinguishable babble.
Their so much data I can't find information.

>    - When the physician/HCP does not usually comment on diagnoses and
>    treatment of another, or even review what is happening to the patient on a
>    daily basis. This even when they *have* access to the computer story.
> While some think we have diagnoses in the computer system, what is
actually presented is the terms used for billing; the terms used for
diagnoses are markedly different. There no fora (like we once had in the
doctors' lounge) for the disparate limited-filed physicians to

>    - There is a culture of non-interference.
> Each stick solely to their field, for sure. And with the demise of the
primary care physician, we now have 5 blind men and an elephant.

>    - When there is an important error in the computer system that is
>    immensely difficult to remove. E.g. “The patient has disseminated
>    carcinoma,” when it is not true. The error repeats time an time again with
>    differing results.
> I have a button where I can cut and paste forward all past errors.
However, I don't need to; this is done automatically for me, which
increases reimbursement to the hospital.

>    - When there are *many* specialists involved in a patient’s care who
>    are not talking to each other, directly, by phone or computer and watching
>    the diagnoses and treatments unfold.
>    - Etc. etc.
> One would ask what needs to be done? Are there barriers that need to be
> broken and new procedures adopted?

The solution is really simple; stop paying for it! The behaviors I see
every day (or, tonight) are as lucrative as they are dysfunctional.
If the end-users had a vote and that vote was directly tied to $ to
vendors, this behavior would cease within 24 hours.
There is a reason retailers have return policies; it's good for business
and the vendors get feedback on the quality (or lack thereof) from the
end-users. We do not have that in healthcare. And the pressure to change
will diminish as newly minted physicians believe this dysfunction is normal.

> Do we leave as is because it is complex?

No; can't. Interface engines can be written to unravel the Tower of Babel.
Chat rooms can be opened. We have the technology; we lack the will. The
pressure for change must come from the patient-side.


> Rob Bell, M.D.
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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