Hindsight bias issues

Thomas Westover twest54973 at YAHOO.COM
Thu Nov 8 20:34:03 UTC 2018


I can’t resist ...

It’s quite ironic that you said >

 “as in all bad outcomes, a POOR choice was made at some point...”  

Laura Zwaan recently showed very eloquently that hindsight bias alters our perception of whether an error has occurred during the decision making process (Zwaan BMJQS 2017)

Ie. if you “know” that an adverse outcome has occurred, you are much more likely to conclude that erroneous decision making occurred than if you “know” that a good outcome occurred (holding the decision making process constant....)

I hope I quoted you correctly Laura :)

Physicians don’t generally make “poor choices”: they make the “best, most prudent” decision based on the available evidence at THAT particular point in time 

It’s only when further time passes, and MORE evidence/data become available , that we realize that the initial decision was “incorrect “

This dynamic process is at the heart of why “inappropriate” decisions are made and why “dx errors” occur

I believe we should  re-classify “dx errors” as dx variability or some other such term that reflects the inherent uncertainty  that occurs during dx decision making especially during the analysis of complex cases 

As you note , one should be cautious in applying retrospective “after the fact” conclusions to prospective decision making...

Respectfully 
Tom

Thomas Westover MD
Cooper Medical School
Camden NJ


Sent from my iPhone

> On Nov 8, 2018, at 1:58 PM, Bob Latino <blatino at RELIABILITY.COM> wrote:
> 
> Agreed.
>  
> As I’ve stated many times on this forum, I see ‘Dx Error’ as a huge cause category.  By itself it is not a bad outcome or near miss where it would be recognized. 
>  
> Dx Error is also not a ‘Root Cause’.  As in all bad outcomes, a poor choice was made at some point along the path(s) to failure.  At that decision point, it should be explored as to ‘Why that decision-maker, on that day, felt it was the appropriate decision?’.  The answers to this question will uncover human reasoning for the decision, which normally was made with good intent.  The answers will uncover deficiencies in our organizational systems/cultural norms and socio-technical systems that influenced the decision-maker.
>  
> As individuals, we tend to judge others based on the outcomes of their decisions.  However, we prefer to be judged based on the intent of our own decisions.
>  
> If an ‘RCA’ concludes with discipline to an individual for a perceived violation of some type, that is basing it on the outcome of their decision. 
>  
> To me, if we are not exploring the intent of the decision, we are not conducting an effective RCA (https://reliability.com/pdf/rca-vs-hpi-2017-rci.pdf) and leaving the door open to recurrence.
>  
> Obviously a topic near and dear to my heartJ
>  
> Bob
>  
> Robert (Bob) J. Latino
> CEO
> Reliability Center, Inc.
> 804-458-0645 (Work)
> 804-452-2119 (Fax)
> blatino at reliability.com
> www.reliability.com
> <image001.jpg>
> Connect on LinkedIn
> 
> <image003.jpg>
>  
> From: Rory Jaffe [mailto:rjaffe at chpso.org] 
> Sent: Thursday, November 08, 2018 1:36 PM
> To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; Bob Latino <blatino at reliability.com>
> Subject: RE: [IMPROVEDX] ECRI Data
>  
> I doubt it was from the PSO data, as the data fields are not well-suited to surveil for diagnostic error. Probably from the expert panel they convened, and probably based on zeitgeist rather than hard data.
>  
> Rory Jaffe, MD MBA, Executive Director, CHPSO
> 1215 K Street, Suite 930
> Sacramento, CA 95814
> rjaffe at chpso.org
> (916) 552-2600
>  
> <image004.jpg>
>  
> Subscribe to CHPSO newsletters and announcements
> <image005.jpg>
>  
> From: Bob Latino <blatino at RELIABILITY.COM> 
> Sent: Thursday, November 08, 2018 9:24 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: [No SPF Record] Re: [IMPROVEDX] ECRI Data
>  
> Thanks for posting this Laurie.  This is what they presented at NAHQ.
>  
> What was interesting to me was that Dx Error was not listed at all on the past 3 years, and out of the blue it came to the top in 2018.  Does anyone know what that is attributable to?  Increased exposure? Better reporting?
>  
> Just curious.
>  
> Robert (Bob) J. Latino
> CEO
> Reliability Center, Inc.
> 804-458-0645 (Work)
> 804-452-2119 (Fax)
> blatino at reliability.com
> www.reliability.com
> <image001.jpg>
> Connect on LinkedIn
> 
> <image003.jpg>
>  
> From: Lorie Slass [mailto:Lorie.Slass at IMPROVEDIAGNOSIS.ORG] 
> Sent: Thursday, November 08, 2018 12:06 PM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: Re: [IMPROVEDX] ECRI Data
>  
> Here is the ECRI report - https://www.ecri.org/EmailResources/PSRQ/Top10/2018_PSTop10_ExecutiveBrief.pdf
>  
>  
>  
>  
> Lorie Slass
> Vice President of Communications and Marketing
> Society to Improve Diagnosis in Medicine (SIDM)
> Lorie.Slass at ImproveDiagnosis.org
> Phone: 215.801.4057
> www.improvediagnosis.org 
> <image006.jpg>
>  
> From: Janet Gilbreath <0000001584f7bb70-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> 
> Sent: Thursday, November 8, 2018 11:52 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: Re: [IMPROVEDX] ECRI Data
>  
> I would love to see the top 10 patient safety concerns for 2018.  Would you mind putting me in touch with the person who presented this?  
>  
> Thanks so much,
> Janet Gilbreath
> Walmart Care Clinics 
>  
> On Thursday, November 8, 2018, 10:40:23 AM CST, Lyn Behnke <lynbehnke at GMAIL.COM> wrote:
>  
>  
> Bob, that would be amazing if I could have access.  I am really interested in diagnostic error related to EHR..
> 
> 
> > On Nov 6, 2018, at 12:45, Bob Latino <blatino at RELIABILITY.COM> wrote:
> > 
> > I spoke at the National Association of Healthcare Quality (NAHQ) this week, and listened to a presentation by a colleague of mine from ECRI. It was entitled ‘The Top 10 Patient Safety Concerns for 2018’.  For the first time Dx Error not only made the list, but topped it.
> > 
> > I spoke with my friend about their event /incident database which houses over 6 million incidents collected via their PSO nationally.  This DB is the basis for determining such Top 10 lists.
> > 
> > I asked her if SIDM could have access to this knowledge base for research purposes and she said they do have such accommodations.  I also asked if this list could be data mined to cull out only bad outcomes resulting from Dx Error and she said yes.
> > 
> > This would be a means of quickly identifying which bad outcomes to focus on per Rob Bells suggestion.
> > 
> > This is just an FYI as this is a pretty substantial database that is maintained very well to keep up the integrity of the data.
> > 
> > If this is worth checking out, let me know and I will connect you with my contact at ECRI.
> > 
> > Bob Latino
> > 
> > Sent from my iPhone
> > 
> > 
> > 
> > 
> > 
> > 
> > Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
> > 
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> > </p>
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> 
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> 
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> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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