[No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic

ROBERT M BELL rmsbell200 at YAHOO.COM
Tue Aug 7 04:01:35 UTC 2018


Is labor action or some other way forward necessary. If they knew what was going on would our patients want us to do something?

Rob Bell, M.D.
> On Aug 6, 2018, at 10:13 AM, Rory Jaffe <rjaffe at CHPSO.ORG> wrote:
> 
> Not to go further off-track, but, I hate the triple aim. Reduced cost should be a fortuitous outcome of improved/more efficient care, not a primary goal.
>  
> Rory Jaffe, MD MBA, Executive Director, CHPSO <http://www.chpso.org/>
> 1215 K Street, Suite 930
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> From: Xavier Prida <dr.xavier.prida at GMAIL.COM <mailto:dr.xavier.prida at GMAIL.COM>> 
> Sent: Monday, August 06, 2018 9:30 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: [No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
>  
> The traditional mantra in QI- "Your outcome(s) is precisely predicated on your processes " satisfies this. Rather than looking back and recognizing this epoch as the "information and evidence age of medicine", it shall be remembered as the economic and business model age. And, it mirrors the capitalist model with many causalties along the way(patients, physicians, systems and communities of care disrupted). 
>  
> And, the most disingenuous part is the corruption of the "triple aim" - the basis of this is the iron triangle(cost, quality, speed)- extension to the "quadruple aim" by CMS. An evolved market model is untesed and unproven as to its ability deliver a quadruple aim.
> 
>  praesent superare odio  (rise above)
>  
> Xavier E. Prida MD FACC FSCAI
> Assistant Professor of Medicine
> Program Director Cardiology Fellowship Training 
> USF Morsani College of Medicine
> Department of Cardiovascular Sciences
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>  
> On Mon, Aug 6, 2018 at 10:08 AM, Bruno, Michael <mbruno at pennstatehealth.psu.edu <mailto:mbruno at pennstatehealth.psu.edu>> wrote:
> Very insightful of Upton Sinclair, and of you too, Dr. Swerlick! 
>  
> We’ve created healthcare systems that do exactly what they were designed to do: maximize revenue.  And they do it quite well, and despite a challenging economic environment in healthcare.  The tradeoff for this very tangible benefit is high levels of physician burnout, a poor patient experience, and sub-optimal quality and safety in patient care.  If we want our healthcare systems to do other things instead, such as provide excellent healthcare to patients, or if we perhaps want our systems to become the kind of working environment that does not produce physician burnout on a massive scale, then we will need to fundamentally redesign them.
>  
> It is the same reasoning that has been applied to the electronic medical record (see the attached article).
>  
> All the best,
>  
> <image005.png>
> Michael A. Bruno, M.S., M.D., F.A.C.R.   
> Professor of Radiology & Medicine
> Vice Chair for Quality & Patient Safety
> Chief, Division of Emergency Radiology
> Penn State Milton S. Hershey Medical Center
> ( (717) 531-8703  |  6 (717) 531-5737
> * mbruno at pennstatehealth.psu.edu <mailto:mbruno at pennstatehealth.psu.edu>  |  
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> From: Swerlick, Robert A [mailto:rswerli at EMORY.EDU <mailto:rswerli at EMORY.EDU>] 
> Sent: Sunday, August 05, 2018 3:44 PM
> 
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
>  
> The skepticism regarding de-biasing is not a either it works or doesn't. It may work in specific circumstances with specific populations. In healthcare delivery, the question is where are those circumstances where training people results is meaningful return on investment and where are the circumstances where the environment (system issues) are so overwhelming that it does not make sense to try to de-bias those who embedded in such systems. 
> 
>  
> 
> The environments I observe are volume driven and financially reward heavy dependence on system one engagement. De-biasing will almost certainly require engagement of system 2 translating to less volume less volume and fewer $'s. Unless there are meaningful changes in how we reward practice activities, this will be a hard sell. I can't help but recall a quote from Upton SInclair:
> 
>  
> 
> “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” 
> ― Upton Sinclair <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.goodreads.com_author_show_23510.Upton-5FSinclair&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=vh01PhKHRcQstqbed504RXqt50ai90tBBh83uy2UDpA&e=>, I, Candidate for Governor: And How I Got Licked <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.goodreads.com_work_quotes_254630&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=XZ61zou8nqPQXpmbb3MVC1kaTox-9nNHUZr68ZLZUE4&e=>
>  
> 
> Robert A. Swerlick, MD
> Alicia Leizman Stonecipher Chair of Dermatology
> Professor and Chairman, Department of Dermatology
> Emory University School of Medicine
> 404-727-3669
>  
>  
> From: Pat Croskerry <croskerry at EASTLINK.CA <mailto:croskerry at EASTLINK.CA>>
> Sent: Sunday, August 5, 2018 11:50:39 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
>  
> Thanks for the link.
> 
>  
> 
> Evidence that the pessimism about bias mitigation is unwarranted is accumulating. Nobody said it would be easy, but nobody should say it can’t be done.
> 
>  
> 
> Nisbett’s work is acknowledged in this piece – his recent book describes a number of strategies: Mindware: Tools for Smart Thinking . 
> 
> Further, a recent review in Medical Decision Making found that most of 74 interventions in 13 studies were effective:
> 
> (Ludolph R, Schulz PJ. Debiasing health-related judgments and decision making: A systematic review. Medical Decision Making 2017; 38 3–13). <>
>  
> 
>   
> 
>  
> 
> From: mgraber <graber.mark at GMAIL.COM <mailto:graber.mark at GMAIL.COM>> 
> Sent: August 5, 2018 11:25 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
> 
>  
> 
> Thanks to Eta Berner for this …..
> 
>  
> 
> https://www.theatlantic.com/magazine/archive/2018/09/cognitive-bias/565775/ <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.theatlantic.com_magazine_archive_2018_09_cognitive-2Dbias_565775_&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=wjcIaC0bj66hhEbrccbPsYAXAeWEvywbC_PzMFSvvbs&e=>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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