Annals of EM Malpractice Editorial

Art Papier apapier at VISUALDX.COM
Thu Feb 15 19:28:13 UTC 2018


I am a medical informaticist (and a dermatologist) working in diagnostic clinical decision support.  I have attended the annual ACEP meeting for about the past 10 years and talked to hundreds of emergency physicians over the years asking them about how they diagnose, and also questions such as if they use point of care evidence tools and decision support.  What I have learned is that emergency physicians, like all physicians, are not some sort of monolithic, homogenous block in how they approach the patient.  I have had emergency physicians stridently assert that EM physicians “do not diagnose, they just deal with disposition as in, is the patient safe to go home, or do they need to be admitted?”.  Seconds later another emergency physician said to me, when I shared what the previous emergency physician said just minutes early, “that is ridiculous, of course emergency physicians diagnose, that’s what we do”.  Again, I have conversations with physicians across medicine including all of primary care, hospitalists…. and this is not a unique phenomena.  Unfortunately there is great variability in the way doctors think, recall, their logical competence, knowledge base, how they use information tools,  talk to their patients and care for their patients.  The variability is quite striking, and is a core problem.   As a result of this variability I believe med students and residents suffer from some sort of educational whiplash as they are exposed to these different styles and abilities.  How do we model for our residents ideal practice if they are seeing strikingly different clinical decision-making methods?  

 To add to what Mark wrote, having the right information at the time of decision making is critical, and to have a complete differential diagnosis.  I recently had an emergency physician contact me to share that our technology helped him diagnose a case of fournier’s gangrene.  He’s using diagnostic CDS, but right next door I am sure he has a colleague that isn’t.  There is an ideal way to fly a 747, and it includes using instruments, check lists and advanced information systems.  Aviation has figured out how to design advanced systems to augment the needs of flight. Medicine is scratching the surface and actually heading backwards with many of the EHR’s that add to cognitive burden.  We have yet to universally embrace the ideal way to clinically problem solve with the help of information technology.  It needs to be done, and promoted, just the way the SOAP note was created and promoted.  Welcome to SIDM!

 

From: Mark Graber [mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG] 
Sent: Thursday, February 15, 2018 1:49 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Annals of EM Malpractice Editorial

 

Thanks for posting this article Keel and welcome to our discussions.

 

I’ll take issue with the implication in the editorial and the  <http://dx.doi.org/10.1016/j.annemergmed.2017.06.023> Venkat article that there is nothing that can be done to prevent malpractice suits in the ED.  I have no argument with the findings that no practice characteristics have been identified to date, but would argue that the interventions we believe could improve diagnosis have not been evaluated in the ED setting so far.  These include: Better patient engagement, better teamwork, better follow-up, and more use of clinical decision-support. 

 

We will have trouble eliminating the ‘crapshoot’ element, but to the extent that we could improve the diagnostic process, there’s hope that at least some fraction of claims could be avoided.

 

   Mark

 

Mark L Graber MD FACP

President, SIDM

Senior Fellow, RTI International

Professor Emeritus, Stony Brook University 



 

 

 

From: Keel Coleman < <mailto:keelcoleman at GMAIL.COM> keelcoleman at GMAIL.COM>
Reply-To: Listserv ImproveDx < <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Keel Coleman < <mailto:keelcoleman at GMAIL.COM> keelcoleman at GMAIL.COM>
Date: Thursday, February 15, 2018 at 8:43 AM
To: Listserv ImproveDx < <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Annals of EM Malpractice Editorial

 

Long time reader, first time poster. 

Attached find an editorial from Annals of Emergency Medicine regarding a study of malpractice claims.

 

The editorial reviews the current literature looking for three things:

1. Are their practice patterns or decisions by EM providers that are associated with increased likelihood of being named in a suit? 

 Answer: No. None that we can find.

 

2. Are there identifiers for EM providers that are associate with likelihood of being named in a suit?

Answer: Yes. Time in practice (number of years), and number of pts seen.

 

3. What other avenues might we study to further understand patterns of malpractice litigation?

Answer: Look at your local patient-plaintiff attorney relationships. 

 

Given these answers, what can be done to first protect patients from the wages of defensive medicine, and deranged decision making driven by the fear of of litigation? 

 

Second, what can be done to support physicians who will certainly find themselves in the crosshairs of litigation despite doing 'the right thing' every day? 

 

Third, as the study of indemnity claims moves to focus on local variability of malpractice environments, how do we maintain objectivity and best practices when a care space becomes adversarial by virtue of its location?  

 

Thank you.

Keel Coleman DO, MBA, FACEP

 

 




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


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