HM Epstein hmepstein at GMAIL.COM
Fri Nov 9 15:12:58 UTC 2018

Hi Tom,

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

I would agree with you, if you remove the word “only” from that sentence. The advancement of medical knowledge impacting current diagnosis is the tip of the iceberg that is diagnostic error. 

I agree with Peggy. While the vast majority of people attend medical school and become physicians because they truly care and the vast majority of physicians are knowledgeable, that doesn’t stop them from making “poor choices.“ Sometimes those poor choices are due to a lack of knowledge, some are due to a lack of time, some due to a lack of critical thinking or cognitive bias. And yes, of course, some are due to the state of medical knowledge falling short of a patient’s symptoms. We don’t know what we don’t know.

My son’s traumatic 15-year diagnostic journey which yielded over 15 different diagnoses from over two dozen clinicians but which was due to four common medical situations. The internist who was touted as being an excellent diagnostician but who misdiagnosed all three of my medical concerns (and her resulting treatment plan cost me harm). The beloved gerontologist who announced my dad had Lewy body and scared him half to death (he had Parkinson’s and died 10 years later and days shy of turning 95). These are just a handful of the poor diagnostic behaviors that have impacted my family. And for the most part, every single one of the clinicians my family worked with were considered among the top in their field in the New York City metro area.

We have a long way to go but I’m so grateful for all of you who are willing to work to identify the problems and address them. 

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On Nov 8, 2018, at 1:58 PM, Susan Carr <000000100bc47bd7-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:

Hi, Bob! ECRI employs art as well as science in constructing its top-10 lists. I'll quote myself from an article I wrote for Patient Safety Beat, the newsletter of the Betsy Lehman Center:

"To choose the Top 10, ECRI draws on the experience of its patient safety organization (PSO) members as well as the expertise of its staff and other professionals working in patient safety. Josi Wergin, Risk Management Analyst at ECRI Institute, explains:

This year, diagnostic errors were strongly represented in all the data sources that we used. We see event reports on diagnostic errors reported to our patient safety organization and our partner PSOs. Our members are asking us about diagnostic errors; they submitted multiple root-cause analyses and requests for custom research on this issue in the last year.
The list varies considerably from year to year, with no topics on the 2017 list reappearing in 2018. Each year, the list suggests resources health care organizations can use to address the 10 problems."

You'll find the full article at:


Newsletter editor for SIDM & Betsy Lehman Center

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

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