Errors in diagnosis and a possible way forward.

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Wed Nov 28 04:15:29 UTC 2018


If I read properly, this is a very limited restriction, and does not apply
to the greater number of patients, "none of the following clinical
laboratory test results and any other related results" references tests for
limited diseases and results and also limitations as to access by
electronic methods.  Still leaves the great majority of tests and results
readily available, and well within the rights of the patient.

What is the general position of the CHPSO in this regard?

Other
Peggy Zuckerman
www.peggyRCC.com


On Tue, Nov 27, 2018 at 4:58 PM Rory Jaffe <rjaffe at chpso.org> wrote:

> California law places a roadblock in sharing information—or at least
> causes a delay. In PAHRA (Patient Access to Health Records)—health and
> safety code 123148, section f states:
>
>
>
> “(f) Notwithstanding subdivision (a), unless the patient requests the
> disclosure, the health care professional deems this disclosure as an
> appropriate means, and a health care professional has first discussed in
> person, by telephone, or by any other means of oral communication, the test
> results with the patient, in compliance with any other applicable laws,
> none of the following clinical laboratory test results and any other
> related results shall be disclosed to a patient by Internet posting or
> other electronic means:
>
> “(1) HIV antibody test, unless an HIV test subject is anonymously tested
> and the test result is posted on a secure Internet Web site and can only be
> viewed with the use of a secure code that can access only a single set of
> test results and that is provided to the patient at the time of testing.
> The test result shall be posted only if there is no link to any information
> that identifies or refers to the subject of the test and the information
> required pursuant to subdivision (h) of Section 120990 is provided.
>
> “(2) Presence of antigens indicating a hepatitis infection.
>
> “(3) Abusing the use of drugs.
>
> “(4) Test results related to routinely processed tissues, including skin
> biopsies, Pap smear tests, products of conception, and bone marrow
> aspirations for morphological evaluation, if they reveal a malignancy.”
>
>
>
> This was intended to protect patients against bad news surprises without
> first having a discussion with the doctor. Well-intended, but you can see
> the problems with translating good intentions into an inflexible law.
>
>
>
>
>
> 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
>
>
>
> [image: CHPSO-logo-tag-outlines] <http://chpso.org/>
>
>
>
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>
> *From:* Peggy Zuckerman <peggyzuckerman at GMAIL.COM>
> *Sent:* Tuesday, November 27, 2018 4:32 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Errors in diagnosis and a possible way forward.
>
>
>
> I assume that getting a single payer system in the US is not going to
> happen in the next few years or beyond.  However, one thing that could
> minimize some of the most troubling error I see in terms of diagnosis for
> cancer patients is in the failure to get reports directly to patients,
> whether labs, imaging and/or pathology.  For many years, patients have been
> told NOT to inquire as to their blood tests, and absolutely have had a
> nearly complete inability to reach those pathology and radiology reports.
> "No news is good news" has led to so many unnecessary errors, whether a
> report has gone astray or the referring physician simply misreading or
> dismissing the information in the reports.
>
>
>
> GIVE patients those reports as soon as they are available.  We can work on
> helping those patients (and their physicians) to understand the
> complexities of those.  Every patient understands the value of extra eyes
> on this kind of information, and appreciates the opportunity to prepare for
> an appointment. Those who finally see earlier reports of visible tumors,
> not 'mentioned' to them by the doctors, perhaps overlooked as the findings
> were not anticipated, or just filed before review, cannot understand why
> these reports are generally withheld.
>
>
>
> A bit of a parallel is the failure to send radiology reports to the
> patient's second opinion doctor, per their request, as the patient is
> thought to be unreliable...
>
> Peggy Zuckerman
> www.peggyRCC.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.peggyRCC.com&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=az90wzbh-2kQiZEIm4TRlhRC1H_oN4dx-Mj9DnjQ2oc&s=3bVcKOrAfFoas8r5jBVn5uPA8mgJch_jZhqDGwx73yY&e=>
>
>
>
>
>
> On Tue, Nov 27, 2018 at 4:10 PM mehran midia <mmidia at cogeco.ca> wrote:
>
> Hello Dr. Bell,
>
>
>
> I am a radiologist in Canada…we do have a single payer but error in
> diagnosis still happening.
>
>
>
> I think having single payers could make it easier do data mining but the
> down of single pay system is hard to implement top of the line expensive
> platform across the enterprise of health care and there is disconnect in
> provisional (State) bureaucracy.
>
>
>
> I think at heart this a data issue and how its affect decisions at
> different stages as much as it is a system and human issue.
>
>
>
> Sincerely,
>
>
>
> Mehran Midia
>
>
>
>
>
>
>
>
>
>
>
> On Nov 27, 2018, at 6:04 PM, Robert Bell <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
>
>
>
>
>
> Dear all
>
>
>
> 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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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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