Errors in diagnosis and a possible way forward.
pheski69 at GMAIL.COM
Wed Nov 28 00:39:39 UTC 2018
I agree with Dr. Bell. When faced with what seems like an insurmountable problem, trying BIG solutions requires great cost and effort. And it usually results in BIG failures.
I favor the approach taken by Paul MacCready when he won the Kremer Prize for human-powered flight with his Gossamer Condor.
The discussion of his approach <https://www.fastcompany.com/1663488/wanna-solve-impossible-problems-find-ways-to-fail-quicker> by Aza Raskin is excellent. Here is the crux:
"The problem was the problem. MacCready realized that what needed to be solved was not, in fact, human-powered flight. That was a red herring. The problem was the process itself. And a negative side effect was the blind pursuit of a goal without a deeper understanding of how to tackle deeply difficult challenges. He came up with a new problem that he set out to solve: How can you build a plane that could be rebuilt in hours, not months? And he did. He built a plane with Mylar, aluminum tubing, and wire.”
Instead of trying to solve The Diagnostic Error Problem, we have to find ways to iteratively find and understand error-sets and then design, test, and distribute changed systems.
On 2018.11.27, at 6:04 PM, Robert Bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:
I could be wrong but it seems that the problems relating to errors in diagnosis are so massive that any health organization/Society that tries to do something gets mired in the weeds with little eventually happening.
It would seem that that it would be good to tackle one thing at time in a significant way and succeed at something.
Also, the piece by Mike Posata is a good example of the influence of money on errors.
My top three areas for research would be:
Supporting a single payer system, like most of the developed world already has, and investigating the benefits of a single payer system in preventing errors in diagnosis.
That would remove so many hurdles we do not need in medicine. A big challenge but collaboratively, I think, could be done.
Identifying the very commonest errors in diagnosis in each specialty, and working hard on those to prevent them - pulmonary medicine would be my first.
Clarifying all the issues regarding laboratory tests, including, ordering, reporting, interpretation, and subsequent action.
My basic message is to tackle something that is likely to produce results, and can be completed in a defined period of time with the available resources.
Comments very welcome.
Rob Bell, M.D.
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