[No SPF Record] Re: [IMPROVEDX] Transfers/referrals

Tom Benzoni benzonit at GMAIL.COM
Tue Jan 9 14:54:42 UTC 2018


I think misdiagnosis must be treated as misdiagnosis without placing "value
judgment."
Placing a patient on an antibacterial agent when they are experiencing a
viral event not only cannot help the patient, it can hurt the community. It
allocates $ to the drug company and the health care system; I get paid more
when I write a script than when I recommend OTC. (If I write ibuprofen 600
mg, an Rx, I get a bonus that I don't get if I recommend (3) 200 mg Advil.
Sorry, I didn't make this system.) Additionally and more worrying to me, if
an antibacterial is written for a viral event, the patient is open to
damage from several angles: we are seeing more C diff infections,
tendonopathy (e.g., ruptured Achilles tendon) is occurring in patients who
cannot benefit from the Rx, and we're inducing "medication-seeking
behavior" in patients who have a self-limited disease. And we haven't even
gotten to "post-antibiotic era" scenarios.
So I would strongly advocate for placing antibacterial Rx for viral illness
as both a diagnostic and therapeutic error.
I understand this will make the % of misdiagnoses skyrocket, but ignoring
it will not make this error disappear.
tom

On Mon, Jan 8, 2018 at 6:03 PM, Rory Jaffe <rjaffe at chpso.org> wrote:

> And even then, methods of getting counts of diagnostic errors are very
> insensitive, unless your definition is very limited.
>
>
>
> You can get pieces of the answer with some reasonable accuracy—e.g.,
> pathology mis-reads, diagnostic errors resulting in malpractice suits. But
> getting the big picture? No, don’t think we have any idea. For example, see
> Graber, M. L. (2013). The incidence of diagnostic error in medicine. BMJ
> Quality & Safety, 22 Suppl 2(Suppl 2), ii21-ii27.
> http://doi.org/10.1136/bmjqs-2012-001615.
>
>
>
> Clinicians in general do a poor job of documenting their cognitive work,
> so unless we actively solicit this information from physicians and their
> patients we’re not going to get anywhere close to an answer.
>
>
>
> And then there’s the issue of what diagnostic errors do we care about
> counting? Misdiagnosing a viral URI as a bacterial infection is more a
> population health issue than an individual patient safety issue, but each
> time that happens we’re dealing with a diagnostic error. The implications
> of this type of error and the types of interventions needed are much
> different from, say, missed diagnoses of dissecting aneurysms in the ED.
>
>
>
> With such a heterogeneous problem as diagnostic error, I’m not sure that
> counting and lumping all errors together to say, for example, “1/3 of all
> errors are diagnostic” is of any use.
>
>
>
> *From:* Harry Burke [mailto:harry.burke at gmail.com]
> *Sent:* Monday, January 08, 2018 3:02 PM
> *To:* Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG>; Rory Jaffe <rjaffe at chpso.org>
> *Subject:* Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX]
> Transfers/referrals
>
>
>
> The incidence depends on how you define diagnostic errors and how you
> detect diagnostic errors.
>
> Sent from my iPhone
>
>
> On Jan 8, 2018, at 5:43 PM, Rory Jaffe <rjaffe at CHPSO.ORG> wrote:
>
> There are no reliable estimates of the incidence of diagnostic errors.
>
>
>
> Rory
>
>
>
> *From:* robert bell [mailto:0000000296e45ec4-dmarc-request at LIST.
> IMPROVEDIAGNOSIS.ORG
> <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
> *Sent:* Sunday, January 07, 2018 10:58 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [No SPF Record] Re: [IMPROVEDX] Transfers/referrals
>
>
>
> Dear all,
>
>
>
> It is said that of the errors in medicine two thirds are standard errors
> while one third are diagnostic (does anyone know where those figures came
> from?).
>
>
>
> It this is true then the next question would seem to be what is the impact
> of standard errors (from computers, hand offs, medication, laboratory and
> radiology errors, etc., etc.) on diagnostic errors. Is it a  small of large
> figure? Are there  any estimates?
>
>
>
> Then the question arises should we as a community/organization be dealing
> in someway with *all* errors and not solely diagnostic.
>
>
>
> In fact, if the standard errors significantly effect diagnoses, will we be
> able to easily prove that any diagnostic approach is worthwhile?
>
>
>
> Will historical analyses work? How would you compensate for standard error
> rates being different in different hospitals and HC facilities.
>
>
>
> Do we need to know the level of effect of standard errors on diagnostic
> errors in different facilities?
>
>
>
> Robert Bell, M.D.
>
>
>
>
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>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
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>
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>






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


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