Errors in diagnosis and a possible way forward.

Robert Bell rmsbell200 at YAHOO.COM
Wed Nov 28 05:01:06 UTC 2018


 Agree with you Peggy.
When we fully treat the patient as part of the medical team that will happen. Presumably for those who request it as some may not wish to participate.
Perhaps that could be a goal for SIDM. Think how many wrong diagnoses would be prevented in just one year if half the population had this option.
Do we know what is going on in the 50 States, or for that matter the countries of the world?
Just recently a family member had a problem that went on for 9 months without diagnosis. Somewhat frustrated they eventually decided to go on-line and try and find out what was the real diagnosis. They were able to come up with what sounded correct. This was communicated and confirmed by a urologist. Medications were prescribed and the patient is now feeling like a new person.
Rob Bell 
    On Tuesday, November 27, 2018, 5:36:12 PM MST, Peggy Zuckerman <peggyzuckerman at GMAIL.COM> wrote:  
 
 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


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> 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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