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

Tom Benzoni benzonit at GMAIL.COM
Thu Aug 9 19:34:02 UTC 2018


I would contend otherwise (as I often do.)
People have a ready source of information. They choose to not use the
knowledge their family doctor has. It is unlikely insurance is the real
reason; I think it's more systematic and at a lower level. If it were
insruance, it would be easy to overcome because such consultations are well
below most people's deductibles. She knows the medical community the same
way a mechanic knows who to trust with his vehicle.

I do not believe I can choose patient empowerment and helplessness at the
same time.

There is a better way.

Tom

On Thu, Aug 9, 2018, 12:58 Ruth Ryan <ruth at ryan-graham.com> wrote:

> Tom and all,
>
>
>
> We can’t blame the patients/public for not demanding one or another type
> or any reporting.  Have you ever tried to find out a hospital’s or
> surgeon’s safety record for a procedure?  Unless it’s CABGs in NY state,
> good luck.  Patients are swamped with reports they can’t rely on or even
> make heads or tails of.  Witness the recent discovery that nursing homes
> have been systematically lying when they report their staffing levels.  So
> much for Nursing Home Compare, a much vaunted public reporting system.
>
>
>
> This is the same mistake as saying patients are blinded to healthcare
> costs because of insurance and they don’t care or comparison shop (see
> e.g., Wall Street Journal, August 1). Have you ever tried to find out the
> cost of a service in advance?  It’s more deliberately opaque, complicated
> and error-prone than even PBM/hospital drug price deals.
>
>
>
> Patients must be involved front and center in defining what information is
> useful to patients, but it’s our responsibility in healthcare to change the
> institutional cultures of shame and blame, and design/produce reports that
> are reliable and useful to the patients and public.  Publishing hospital
> prices should be the first step but will be bitterly fought.
>
>
>
> Ruth Ryan
>
>
>
> *From:* Mark Gusack <gusackm at COMCAST.NET>
> *Sent:* Thursday, August 09, 2018 12:48 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] FW: Cognitive
> Biases and the Human Brain - The Atlantic
>
>
>
> Good Afternoon:
>
>
>
> I agree with this dystopian scenario.  I’ve seen it happen.  However, I
> have also seen hospitals buy up these outlying clinics because procedures
> done at them can be broken down by individual CPT codes generating lots of
> additional income over what can be billed in the hospital setting.  And, of
> course, when they move in and take over, they make the clinics more
> ‘efficient’ and, therefore, often less safe.
>
>
>
> Mark Gusack, M.D.
>
> President
>
> MANX Enterprises, Ltd.
>
> 304 521-1980
>
>
>
> *From:* Tom Benzoni <benzonit at GMAIL.COM>
> *Sent:* Thursday, August 9, 2018 11:57 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] FW: Cognitive
> Biases and the Human Brain - The Atlantic
>
>
>
> As the dystopian:
>
> When a plant makes an error, the cost of that error is born by that entity.
>
> When an error occurs in a hospital, it profits.
>
>
>
> Former life, a tale of 2 patients, 2 physicians, same hospital:
>
>
>
> Capable physician #1 performs a procedure at an outpatient facility;
> patient goes home, does fine.
>
>
>
> Doc #2, same procedure, same risk factors, less capable, does same
> procedure with less expertise using hospital facilities.
>
> 3 procedures later, 3 ICU days, complications galore, patient is
> transferred out.
>
>
>
> Which physician is preferred by the hospital?
>
>
>
> It's OK to go there in your thoughts. Because one made no money for the
> hospital, the other did.
>
> And the hospital has the same pressures as any industry: make money or die.
>
>
>
> The public is not really interested in having these reported, despite what
> is said.
>
> This is evidenced by the erosion in support of confidential reporting.
>
> If the public really wanted this handled, there would be solid support for
> a system to permit reports without fear of retribution, but the safe
> harbors for reporting have vanished.
>
>
>
> tom benzoni
>
>
>
>
>
>
>
>
>
> On Thu, Aug 9, 2018 at 10:44 AM Bob Latino <blatino at reliability.com>
> wrote:
>
> From Rory's Post - "*Reduced cost should be a fortuitous outcome of
> improved/more efficient care, not a primary goal*"
>
>
>
> I'm an outsider that specializes in Operational Reliability in the high
> hazard industries (i.e. - Oil and Gas, Chemicals, Nuclear).  I am quite
> familiar with the 'triple aim'.  I agree with Rory's statement above as it
> is practiced daily in many of the industries I deal in.
>
>
>
> While I understand the 'operations' are different between HC and these
> continuous process industries, they are all 'systems' when broken down into
> their manageable components and process flows.
>
>
>
> My friend Ron Moore is a Reliability pioneer and has studied the
> relationship between Reliability and Safety in detail.  I have attached a
> paper of his entitled *'A Reliability Plant is a Safe Plant is a
> Cost-Effective Plant*'.  Is a Reliable Hospital a safe and cost-effective
> hospital?
>
>
>
> In my experience HC tends to resist comparing themselves to outside
> industries, but from a system's perspective, I think there may be
> applicable analogies here. What do you all think?
>
>
>
> Bob
>
>
>
> *Robert J. Latino, CEO*
>
> Reliability Center, Inc.
>
> 1.800.457.0645
>
> blatino at reliability.com
>
> www.reliability.com
>
> [image: linkedin logo signature file]
> <https://www.linkedin.com/company/958495?trk=tyah&trkInfo=clickedVertical%3Acompany%2CclickedEntityId%3A958495%2Cidx%3A1-1-1%2CtarId%3A1464096807851%2Ctas%3Areliability%20center%2C%20inc.>
>
>
>
> *From:* ROBERT M BELL [mailto:
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
> *Sent:* Tuesday, August 07, 2018 12:02 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] FW: Cognitive
> Biases and the Human Brain - The Atlantic
>
>
>
> 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
> Sacramento, CA 95814
> rjaffe at chpso.org
> (916) 552-2600
>
>
>
> <image001.jpg> <http://chpso.org/>
>
>
>
> Subscribe to CHPSO newsletters and announcements
> <https://urldefense.proofpoint.com/v1/url?u=http://eepurl.com/rNG3T&k=q2ic6PGnSSvGRm9uYENyDA%3D%3D%0A&r=1aaywgLlHZ49GLomgN2gpcNMVuk1qp9k63bo%2BqwiIHQ%3D%0A&m=nPo4DNBluQoKznFSpyRgz65%2Ffkdcc45e0bJdcK4fOdA%3D%0A&s=002145da16c17f816d8bd5309d7966b755c6462eb3621af67612bf8c116d1f8a>
>
> <image004.jpg> <http://www.hqinstitute.org/hqi2018>
>
>
>
> *From:* Xavier Prida <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
>
> 2 Tampa General Circle
>
> STC 5 th Floor
>
> Tampa, Fl 33606
>
> 813 259 0992(O)
>
>
>
>
>
> On Mon, Aug 6, 2018 at 10:08 AM, Bruno, Michael <
> 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  |
> <image006.png>
>
>
>
> *****E-Mail Confidentiality Notice*****
> This message (including any attachments) contains information intended for
> a specific individual(s) and purpose that may be privileged, confidential
> or otherwise protected from disclosure pursuant to applicable law.  Any
> inappropriate use, distribution or copying of the message is strictly
> prohibited and may subject you to criminal or civil penalty.  If you have
> received this transmission in error, please reply to the sender indicating
> this error and delete the transmission from your system immediately.
>
>
>
>
>
> *From:* Swerlick, Robert A [mailto:rswerli at EMORY.EDU]
> *Sent:* Sunday, August 05, 2018 3:44 PM
>
>
> *To:* 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>
> *Sent:* Sunday, August 5, 2018 11:50:39 AM
> *To:* 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>
> *Sent:* August 5, 2018 11:25 AM
> *To:* 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=>
>
>
>
>
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FSUBED1-3DIMPROVEDX-26A-3D1&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=myYHBYKvx33xHafNpBdRay-4kTsmZU4lxzGpWDsGIgA&e=>
>  or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FINDEX&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=iETbYN8NAG_XJ-9sS48Wtx9jTgnbuGrdax_fq8ScjRo&e=>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=s-TTG-y3uXZSHhSnecL6c6DzrQevJmBy2Ees0OkOaKk&e=>
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FSUBED1-3DIMPROVEDX-26A-3D1&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=myYHBYKvx33xHafNpBdRay-4kTsmZU4lxzGpWDsGIgA&e=>
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
>
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/






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


HTML Version:
URL: <../attachments/20180809/1c2bb899/attachment.html>


More information about the Test mailing list