Stuck in a rut of negative despair?

HM Epstein hmepstein at GMAIL.COM
Wed May 30 19:47:59 UTC 2018

In a few clinical studies currently underway, a decision was made to use the term Missed Opportunities to Improve Diagnosis rather than Dx Errors. I believe this was initiated by Dr. Hardeep Singh and is being utilized in studies led by Dr. Prashant Mahajan. If I recall correctly, the thought process was similar to your concerns, hoping that the correct emphasis on finding ways to improve the quality of diagnosis was better than the perception that measuring Dx error was about pointing fingers and finding blame. 

As a concerned party, I understand and agree with this logic but as a patient advocate I remain concerned that the phrase sounds cavalier to patients, and their families, who have been significantly injured by inaccurate diagnoses. Study results need to be sensitive to potential patient and patient advocacy group readers. 


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On May 29, 2018, at 11:19 PM, ROBERT M BELL <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:

Dear all, 

As many of you know I have been worried that, for more than 20 years, we seem to be making little progress in reducing errors in medicine, as a whole.

My recent thinking is that Error is such a negative word that everyone, for many reasons runs away from it! An error often causes such anger/hurt, financial loss, and lack of of prestige that it is not/never easily talked about. Consequently, errors are one way or another camouflaged or completely hidden from view. 

And presumably this is all tied in many ways to litigation risk and/or financial loss. 

This means that little happens to solve the basic problems. One could ask are we ever going to solve the problem if these barriers continue to exist?

So how do we make a break through? How to further help our patients?

Could we brainstorm several good ideas, or even a combination of these, to come up with a program/study that could be presented to one, two, or three State Legislatures that in exchange for altering/modifying the current litigation regulations WE provide reductions in errors in medicine with improved medical care.

Presumably one would need a well designed study to be undertaken and completed.

Also, hospitalization is not all bad, and if there were published accurate figures of success would the bad/error things tend to be drowned out, eventually letting one better concentrate on reducing all errors/adverse events? All this can occur by keeping better more accurate figures, doing more RCAs, understanding errors, and having a culture of excellence in all areas - and that more often comes from the top. 

And I know that this occurs in many places but needs to be spread around, etc.

And I am sure/suspect there will be many other ways to move forward.

One could ask are we are stuck in a rut of unrelenting negativity?

Do we need defined time-related goals? Do we need to collaborate with other organizations for solutions? Do we need courteous and polite activism? 

Do we need to be more BOLD? 

Would welcome thoughts and ideas.

Rob Bell M.D.

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