What is evidence in diagnosis

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Wed Mar 21 18:21:43 UTC 2018


Bob, your point is well made. The probability or frequency of an event is not evidence for the event in a particular instance. It only represents the chance of the event in the particular instance. Whether the event occurred then or not is decided by evid3nce in form of likelihood ratio. Your example of a detective in this regard is right on the mark. We have a similar situation in diagnosis.

Bimal

From: Bob Latino [mailto:blatino at reliability.com]
Sent: Wednesday, March 21, 2018 1:28 PM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; Jain, Bimal P.,M.D. <BJAIN at PARTNERS.ORG>
Subject: RE: What is evidence in diagnosis

Thank you Bimal.

Tell me if I am making a correct analogy to your point below.

I am in the investigative/RCA business.  I see it all the time in healthcare when observing RCA teams, they will use a 'literature search' to validate a hypothesis in any given RCA on some undesirable outcome.  I tell them while a literature search may help somewhat determine the probability of that hypothesis occurring overall, it is not a valid form of evidence to conclude it occurred in this particular case.  A literature search is representative of experience outside of this case, which cannot conclude anything about this specific case.

I can't imagine a detective doing a literature search to draw a conclusion about how and/or why a certain crime occurred.

Many are not receptive to this perspective of mine as oftentimes literature searches are acceptable forms of evidence in healthcare RCAs.

Am I comparing apples to apples?

Bob

Robert J. Latino, CEO
Reliability Center, Inc.
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From: Jain, Bimal P.,M.D. [mailto:BJAIN at PARTNERS.ORG]
Sent: Wednesday, March 21, 2018 1:00 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] What is evidence in diagnosis

In this attached paper, I discuss how evidence is assessed during diagnosis in practice .I argue that evidence is not assessed by a probability as prescribed because a probability which is a frequency in a population fails to represent evidence for a disease in a given, individual patient in whom diagnosis is performed. Instead evidence is assessed in terms of likelihood ratio and a disease diagnosed from it in practice as we see in all published CPCs and clinical problem solving exercises.
Please review and comment on this paper.
Thanks.

Bimal

Bimal P Jain MD
Northshore Medical Center
Lynn MA 01904.

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


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