[External] [IMPROVEDX] Recent articles of note

Ely, John john-ely at UIOWA.EDU
Thu Oct 4 12:58:49 UTC 2018


Two great articles from Gordy Schiff and David Newman-Toker.  Gordy says we should communicate honestly about uncertainty, but the medical profession has strong cultural norms against this.  David says we should reach for the low hanging fruit, but the lowest of the low is to target the most common cause of diagnostic errors, which was not mentioned in either article.  The most common cause of diagnostic errors is the failure to consider the correct diagnosis as a possibility. (1,2)  It never gets on the radar screen.  Reviewing a differential diagnosis checklist, preferably in the presence of the patient, could force us to consider the correct diagnosis.  We still need knowledge and experience to know which diagnoses on the list are reasonable possibilities and which should be ruled out before the patient leaves.  We can maintain our cultural norms by first stating what we think the patient has before reviewing the differential diagnosis.  Stating what we think reassures the patient that we’re not completely in the dark.  Reviewing the differential diagnosis reassures the patient that we are being thorough, and avoids the need for the patient to ask “What else could this be?”  (which is our job, not theirs)  Reviewing a diagnostic checklist is Pat Croskerry (de-biasing).  Knowing which diagnoses on the list are serious considerations is Geoff Norman (knowledge and experience).

1.            Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009;169(20):1881-7.

2.            Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493-9.

John W. Ely, MD
University of Iowa





From: mgraber [mailto:graber.mark at GMAIL.COM]
Sent: Wednesday, October 03, 2018 5:17 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [External] [IMPROVEDX] Recent articles of note

FYI -  Two significant articles just published …..

Ten Principles for More Conservative, Care-Full Diagnosis
http://annals.org/aim/article-abstract/2705208/ten-principles-more-conservative-care-full-diagnosis

Where Is the “Low-Hanging Fruit” in Diagnostic Quality and Safety?
https://journals.lww.com/qmhcjournal/Citation/2018/10000/Where_Is_the__Low_Hanging_Fruit__in_Diagnostic.9.aspx



Mark L Graber, MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University, NY

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