Errors in diagnosis and a possible way forward.

George Reigeluth greigeluth at AOL.COM
Wed Nov 28 17:46:25 UTC 2018


Jason: Your suggestion of requiring a differential diagnosis is one example of what Larry Weed was talking about when discussing the need for standards for the quality of the inputs that go into health care decisions - just like every other industry has, but hc still does not. Beyond requiring a differential dx, there should also be standards for the quality of the diff dx, etc. Lots to discuss here. Best, George


-----Original Message-----
From: Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Wed, Nov 28, 2018 8:20 am
Subject: Re: [IMPROVEDX] Errors in diagnosis and a possible way forward.

#yiv2348711857 #yiv2348711857 -- _filtered #yiv2348711857 {font-family:Helvetica;panose-1:0 0 0 0 0 0 0 0 0 0;} _filtered #yiv2348711857 {font-family:Wingdings;panose-1:5 0 0 0 0 0 0 0 0 0;} _filtered #yiv2348711857 {panose-1:2 4 5 3 5 4 6 3 2 4;} _filtered #yiv2348711857 {font-family:DengXian;panose-1:2 1 6 0 3 1 1 1 1 1;} _filtered #yiv2348711857 {font-family:Calibri;panose-1:2 15 5 2 2 2 4 3 2 4;} _filtered #yiv2348711857 {panose-1:2 1 6 0 3 1 1 1 1 1;} #yiv2348711857 #yiv2348711857 p.yiv2348711857MsoNormal, #yiv2348711857 li.yiv2348711857MsoNormal, #yiv2348711857 div.yiv2348711857MsoNormal {margin:0cm;margin-bottom:.0001pt;font-size:11.0pt;font-family:sans-serif;} #yiv2348711857 a:link, #yiv2348711857 span.yiv2348711857MsoHyperlink {color:blue;text-decoration:underline;} #yiv2348711857 a:visited, #yiv2348711857 span.yiv2348711857MsoHyperlinkFollowed {color:purple;text-decoration:underline;} #yiv2348711857 p.yiv2348711857msonormal0, #yiv2348711857 li.yiv2348711857msonormal0, #yiv2348711857 div.yiv2348711857msonormal0 {margin-right:0cm;margin-left:0cm;font-size:11.0pt;font-family:sans-serif;} #yiv2348711857 span.yiv2348711857EmailStyle19 {font-family:Helvetica;} #yiv2348711857 .yiv2348711857MsoChpDefault {font-size:10.0pt;} _filtered #yiv2348711857 {margin:72.0pt 72.0pt 72.0pt 72.0pt;} #yiv2348711857 div.yiv2348711857WordSection1 {} #yiv2348711857 _filtered #yiv2348711857 {} _filtered #yiv2348711857 {font-family:Symbol;} _filtered #yiv2348711857 {} _filtered #yiv2348711857 {font-family:Wingdings;} _filtered #yiv2348711857 {font-family:Wingdings;} _filtered #yiv2348711857 {font-family:Wingdings;} _filtered #yiv2348711857 {font-family:Wingdings;} _filtered #yiv2348711857 {font-family:Wingdings;} _filtered #yiv2348711857 {font-family:Wingdings;} _filtered #yiv2348711857 {font-family:Wingdings;} #yiv2348711857 ol {margin-bottom:0cm;} #yiv2348711857 ul {margin-bottom:0cm;} #yiv2348711857 Rob You are still trying to address some almost insurmountable issues like a single payor system.    My view has always been that our missing final link is a measure that regulators can use. They may agree with everything we say and want to include something on diagnosis but need a measure to make it happen. We have spent too long talking about perfect measures and just need 3 (or even one!) that we can agree on and are practical. Hence my long-standing suggestion that the recording of a differential diagnosis in the notes should become a requirement. It makes clinical sense and will be easy to implement and measure if one is present or not.    This small but important measure could start to drive a huge change in behaviour.    An historical example is the abolition of the slave trade in the UK. This was finally achieved via an obscure change in legislation that removed protection for ships flying under the then neutral US flag. It meant that within 2-3 years 80% of the operators in the UK went out of business and then abolition by parliament became easy. The lesson is this seemingly small technical change achieved what 20 years of head on battling had failed to achieve!    Regards Jason      From: Robert Bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Robert Bell <rmsbell200 at YAHOO.COM>
Date: Tuesday, 27 November 2018 at 23:13
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Errors in diagnosis and a possible way forward.       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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