[External] Re: [IMPROVEDX] How to convey uncertainty

Applegate, Kimberly keapple at UKY.EDU
Fri Jan 12 13:13:37 UTC 2018


Here is another interesting way to talk to parents and families, as well as healthcare providers, about uncertainty and risk--in pediatric radiology:

http://www.imagegently.org/



It is based on 11 years of volunteers working to educate, advocate, and change practice toward more appropriate use of imaging in children worldwide. It provides explicit (but avoids scary) language and tools for how to talk about the risk of ionizing radiation use in medicine.

 We invite all stakeholders, apply social marketing, transparency, respect for all members of the team, include a parent advocate, and learn from each imaging campaign.



Here is one example: The 'Think-A-Head Campaign for minor head trauma poster:

http://www.imagegently.org/Procedures/Minor-CT-in-Head-Injuries

Think-A-Head on Children's CT Scans

If kids hurt their heads, help families make informed decisions:

  *   Know when an imaging test is (and is not) necessary
  *   Explain why a head CT scan is (or is not) the right choice

  *   Discuss the benefits as well as the risks of the scan

  *   Child-size the CT radiation dose (where necessary)

This is a bottom up, low budget approach.

Kimberly



Kimberly E. Applegate, MD, MS, FACR, FAAP
Division Chief of Pediatric Radiology
Professor of Radiology and Pediatrics
Quality Liaison to Kentucky Children's Hospital
Department of Radiology
University of Kentucky
800 Rose St. Rm HX313
Lexington, KY 40536
Phone: 859-323-2105
keapple at uky.edu<mailto:keapple at uky.edu>

mobile: 404-276-3446

________________________________
From: Ely, John [john-ely at UIOWA.EDU]
Sent: Thursday, January 11, 2018 8:33 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] [External] Re: [IMPROVEDX] How to convey uncertainty

The best option may be a combination of the two implicit strategies:  “You child’s belly pain is probably due to Disease A, but could also be due to Disease B or Disease C.  And this is what we need to do to rule out B and C.  And before you leave, I just want to run through this checklist of other possibilities to be sure I’m not forgetting anything else that we need to rule out.”

John Ely, MD
University of Iowa

From: Bob Latino [mailto:blatino at RELIABILITY.COM]
Sent: Thursday, January 11, 2018 5:23 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [External] Re: [IMPROVEDX] How to convey uncertainty

Along these lines some friends of mine wrote this book a while back 'What Do I Say?' that addresses these uncomfortable conversations that need to take place between a physician and a patient.  This is targeted to obstetrics but the basic premise is about communicating information to people that otherwise would not want to hear it (bad news).

https://www.amazon.com/Communicating-Intended-Unanticipated-Outcomes-Obstetrics/dp/0787966541<https://exchange.uky.edu/owa/redir.aspx?REF=O-Dq1Zq1MJ_8472Uh0K4R9nZuTIq7JuRQOYPCioR9uH3xW2Iu1nVCAFodHRwczovL3d3dy5hbWF6b24uY29tL0NvbW11bmljYXRpbmctSW50ZW5kZWQtVW5hbnRpY2lwYXRlZC1PdXRjb21lcy1PYnN0ZXRyaWNzL2RwLzA3ODc5NjY1NDE.>

Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com<https://exchange.uky.edu/owa/redir.aspx?REF=XIftH8ixebLb_xC0_RqCZyc3_9lxJv6fqRE22wwSXMf3xW2Iu1nVCAFtYWlsdG86YmxhdGlub0ByZWxpYWJpbGl0eS5jb20.>
www.reliability.com<https://exchange.uky.edu/owa/redir.aspx?REF=ZQ9hSQ-FIrF2gaKytpkgZNmRFujc3rCsSLOw8oSQfSf3xW2Iu1nVCAFodHRwOi8vd3d3LnJlbGlhYmlsaXR5LmNvbQ..>
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From: Mark Graber [mailto:graber.mark at GMAIL.COM<https://exchange.uky.edu/owa/redir.aspx?REF=Wc_xKlXDtfzgKwTxoG_AH7jfpgkWA01bWwfrFFhurjP3xW2Iu1nVCAFtYWlsdG86Z3JhYmVyLm1hcmtAR01BSUwuQ09N>]
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To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<https://exchange.uky.edu/owa/redir.aspx?REF=rT7mVl9W-TotzUL5-kgg3Xik5HslW56U1qCq93GA60X3xW2Iu1nVCAFtYWlsdG86SU1QUk9WRURYQExJU1QuSU1QUk9WRURJQUdOT1NJUy5PUkc.>
Subject: [IMPROVEDX] How to convey uncertainty

Congratulations and thanks to Viraj Bhise and Hardeep Singh’s group for their novel study on the best way to convey uncertainty to patients about the diagnosis – advice we can use every day.

https://academic.oup.com/intqhc/advance-article/doi/10.1093/intqhc/mzx170/4791877<https://exchange.uky.edu/owa/redir.aspx?REF=qWzjAWGlVK2oVHSho4AIE3boWVu2RulSSx7ThwZ0VpH3xW2Iu1nVCAFodHRwczovL2FjYWRlbWljLm91cC5jb20vaW50cWhjL2FkdmFuY2UtYXJ0aWNsZS9kb2kvMTAuMTA5My9pbnRxaGMvbXp4MTcwLzQ3OTE4Nzc.>


Mark L Graber MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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