Diagosesmadeforus

Robert Bell rmsbell200 at YAHOO.COM
Sun Mar 11 21:39:16 UTC 2018


 Thanks Dr. Hoffer,
Does that mean that some of the tests not volunteered in the campaign may or may not help us in diagnoses because of financial considerations?
Do we need to know what tests are worthwhile?  Should all medical tests have a rating based on their overall value and level of error in different hands?
Surely, we cannot make good diagnoses when we seem to be surrounded by a plethora of error that we mainly know nothing about.
Where do personal biases rank in diagnoses against this background of confusion?
What is to be done?
Rob Bell, M.D.

   On Sunday, March 11, 2018, 1:44:44 PM MST, Edward Hoffer <ehoffer at gmail.com> wrote: 
 
 I would like to comment on the issue of specialty society recommendations, which are clearly fraught with self-service.A wonderful example is found in the suggestions made in response to the ABIM's "choosing wisely" campaign. Various specialty societies were asked to suggest 5 tests or procedures that "should be questioned."If you look at these, they are remarkable for suggesting things that if avoided would not harm the pocketbooks of society members.Ed
Edward P Hoffer MD
On Sun, Mar 11, 2018 at 4:02 PM, Robert Bell <0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

 Thanks  Helene,
Some good additional points.
I like you bringing up the grassroot activities. It would be good to know what is truly working and where there is evidence-based research that saves lives, prevents injury, and safely advances the overall error cause. So little seems focussed on doing something that is truly a big advance like Peter Pronovost's work in preventing central venous catheter infections. https://en. wikipedia.org/wiki/Peter_ Pronovost  Are there similar breakthroughs that are supported by disease group grassroot efforts.  Are there any that we are missing that could perhaps be extrapolated to other parts of medicine?
Are we looking at the influence of money in specialty society recommendations?
So many questions.
Thanks for your comments.
To help the error movement along I would love to see time-related goals for studies that can be shown to save lives and help patients more.
Rob Bell





   On Saturday, March 10, 2018, 8:26:37 PM MST, HM Epstein <hmepstein at gmail.com> wrote: 
 
 Dr. Bell:
Having personal experience with testing error because of how the doctor’s office mishandled the sample, I’m glad you’re raising these questions. There have been several studies I’m aware of on lab errors due to patient mixups and multiple passes at reading CTs and MRIs and X-rays that demonstrate a disturbingly high rate of second-guessing and error by the same radiologist or different radiologists in the same lab. 
I hope some of the researchers will tell us specifically what they’ve done or are currently working on. 
Of course, I’m certain you are aware that every year new Dx guidelines come out for various diseases/conditions. Many of the latest Diagnostic advancements are happening in the precision medicine field which is exploding. New more reliable diagnostic tests and retrospective studies that challenge the final Dx in each specialty may eventually impact the guidelines. 
But there are also many grassroots efforts happening at the patient-led disease specific organizations. For example, Lyme disease patients are extremely active in funding new research into the life cycle and the co-infection rates of the various tick breeds, which has a direct impact on the diagnostic guidelines. They have also raised funds to finance new methods of identifying the wide range of tick-borne diseases. The same is true for many other disease specific groups from rare genetic diseases to pediatric cancers to neurological and psychiatric conditions. 
I echo your concern though about financial influences from pharma and insurance companies who fund some of the disease specific groups. The first one that comes to mind is CHADD which as far back as 1995 was generously funded by the manufacturer of Ritalin. It’s hard to believe that the ever-broadening of the ADHD diagnostic guidelines for children and adults hasn’t been influenced by the efforts of the pharma companies. (Great book on this topic is ADHD Nation by Alan Schwarz). 

Looking forward to reading what others are working on. 
Best,Helene
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On Mar 10, 2018, at 4:23 PM, Robert Bell <0000000296e45ec4-dmarc- request at LIST.IMPROVEDIAGNOSIS. ORG> wrote:

Dear all,
As you know I have been interested in understanding the errors of all the "tests" that we use to diagnose clinical conditions. We have little idea of many of the degrees of error in different people's hands. What is the impact of all these errors on accurate diagnoses, and do we need to know about the issue/problem? Is there even a problem?  Do we need to fix these at the same time we are refining diagnostic processes? 
Also, others (specialty societies mainly) define certain conditions for us. I have often wondered how accurate these recommendations are. The renal failure categories for example and is there ever a financial influence at play? Have we ever looked at these in some organized fashion?
Robert Bell, M.D.
 
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