What is evidence in diagnosis

Phillip Benton pgbentonmd at AOL.COM
Fri Mar 23 18:44:14 UTC 2018


Bob,
Attached is a project that is still in the concept stage, planning for grant application. The first major hurdles are the advancement of artificial intelligence (AI) capabilities AND the expansion of EHR to include all of the necessary elements without being prohibitively burdensome on the persons with the facts. 

The AI conclusion would be a probable root / contributing causal analysis to be confirmed by humans with the proper experience. It might enter into mediations and lead to  more just settlements, but would not be admissible in court like all other things occurring in court ordered mediation. 
 
The big thing would be  that remedial measures would be mandated and the information disseminated (without names of the parties), rather than hidden in a non-disclosure agreement as is done now. Its whole purpose is for medical education and prevention of future medical error and significant patient harm. 
 
Some, like The Joint Commission, will complain that legislation that requires mandatory RCA and appropriate remedial measures is too proscriptive, but isn't Public Safety the basic point of most of our laws that determine conduct? 

This is admittedly aspirational but I think the result could be worth all of the effort required. Please give me your thoughts.
PGB 

Phillip G. Benton, MD, JD
Orthopedic Spinal Surgeon (ret.)
Adjunct Prof., Emory Law School
Atlanta, Georgia
pgbentonmd at aol.com


 
 
-----Original Message-----
From: Bob Latino <blatino at RELIABILITY.COM>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Wed, Mar 21, 2018 2:28 pm
Subject: Re: [IMPROVEDX] 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.
1.800.457.0645
blatino at reliability.com
www.reliability.com


 

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
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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