how to teach about cognitive bias

Hamm, Robert M. (HSC) Robert-Hamm at OUHSC.EDU
Fri Dec 7 19:52:06 UTC 2018



From: Peter Rudd [mailto:rudd at STANFORD.EDU]
Sent: Friday, December 7, 2018 11:56 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [EXTERNAL] Re: [IMPROVEDX] how to teach about cognitive bias

Could this be the article?

Elkin PL, Liebow M, Bauer BA et al. The introduction of a diagnostic decision support system (dxplain™) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging diagnostic related groups (drgs). Int J Med Inform. 2010;79 (11):772-777.

Unfortunately, I could not find a link for a free pdf.

Peter Rudd, MD, FACP
Professor of Medicine, emeritus
Stanford University School of Medicine
rudd at stanford.edu<mailto:rudd at stanford.edu>

====


On Dec 6, 2018, at 9:35 PM, Paul Seegers <Paul.Seegers at PALGA.NL<mailto:Paul.Seegers at PALGA.NL>> wrote:

Dear Ed,

Do you this article from Elkins at hand? Or a link, because I 'm very interesting in that.

Best regards,
Paul



Verzonden vanaf mijn Samsung Galaxy-smartphone.


-------- Oorspronkelijk bericht --------
Van: Ed Hoffer <ehoffer at GMAIL.COM<mailto:ehoffer at GMAIL.COM>>
Datum: 07-12-18 03:36 (GMT+01:00)
Aan: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Onderwerp: Re: [IMPROVEDX] how to teach about cognitive  bias

A study by Elkin et al from Mayo Clinic showed that when admitting residents were obliged to use a decision support computer program on all non-obvious admissions, patients got out a day faster and hospital costs were about $900 less. Presumably because of a better initial differential.
Edward Hoffer MD
Sent from my iPhone

On Dec 6, 2018, at 2:21 PM, Lorie Slass <Lorie.Slass at IMPROVEDIAGNOSIS.ORG<mailto:Lorie.Slass at IMPROVEDIAGNOSIS.ORG>> wrote:
There is info on the SIDM site that may be helpful –


  1.  Assessment of Reasoning Tool<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_art_&d=DwMGaQ&c=VjzId-SM5S6aVB_cCGQ0d3uo9UfKByQ3sI6Audoy6dY&r=uk-mbUg20DlnPXUYCY2epumJmrVwlvTgZaobOap9ADg&m=GZsZy_6j3VhBjFq3gFFC04CCLFDnCsbNHpBpHvvnM0k&s=Uc0AOivB-xX2I03NKK36Ad97WeU0XAUPFT7hPukDEO8&e=> – this was developed as a tool to support educators in assessing a learner’s clinical reasoning skills during patient presentations. On the page there are a number of videos that look at elements of clinical reasoning.
  2.  The Clinical Reasoning Toolkit<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_clinicalreasoning_&d=DwMGaQ&c=VjzId-SM5S6aVB_cCGQ0d3uo9UfKByQ3sI6Audoy6dY&r=uk-mbUg20DlnPXUYCY2epumJmrVwlvTgZaobOap9ADg&m=GZsZy_6j3VhBjFq3gFFC04CCLFDnCsbNHpBpHvvnM0k&s=yN_nP1blqFTMP2Wn262-24fpWlEUUCsAHisi3ZdsVi0&e=> includes great resources.  Resources in the ‘how we make decisions’ section includes many that focus on cognitive bias - https://www.improvediagnosis.org/clinical-reasoning-toolkit-how-we-make-decisions/<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_clinical-2Dreasoning-2Dtoolkit-2Dhow-2Dwe-2Dmake-2Ddecisions_&d=DwMGaQ&c=VjzId-SM5S6aVB_cCGQ0d3uo9UfKByQ3sI6Audoy6dY&r=uk-mbUg20DlnPXUYCY2epumJmrVwlvTgZaobOap9ADg&m=GZsZy_6j3VhBjFq3gFFC04CCLFDnCsbNHpBpHvvnM0k&s=fnhKpLDfIUsJyxhtibyT4SSw1rpMJB44PI0qEwJf2Sk&e=>
  3.  We maintain a ‘foundational reading’ section<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_foundational-2Dreadings_&d=DwMGaQ&c=VjzId-SM5S6aVB_cCGQ0d3uo9UfKByQ3sI6Audoy6dY&r=uk-mbUg20DlnPXUYCY2epumJmrVwlvTgZaobOap9ADg&m=GZsZy_6j3VhBjFq3gFFC04CCLFDnCsbNHpBpHvvnM0k&s=FBT16GqOXPtwIbUBDQJCrmaXvFR2W0kK2QdujCK5rwI&e=> that includes readings/studies related to cognitive reasoning.

Hope these are helpful.


_________________________________________
Lorie Slass
Vice President of Communications and Marketing
Society to Improve Diagnosis in Medicine (SIDM)
Lorie.Slass at ImproveDiagnosis.org<mailto:Lorie.Slass at ImproveDiagnosis.org>
Phone: 215.801.4057
www.improvediagnosis.org<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DwMGaQ&c=VjzId-SM5S6aVB_cCGQ0d3uo9UfKByQ3sI6Audoy6dY&r=uk-mbUg20DlnPXUYCY2epumJmrVwlvTgZaobOap9ADg&m=GZsZy_6j3VhBjFq3gFFC04CCLFDnCsbNHpBpHvvnM0k&s=I5WOw4dVbHNxTLpFivwky2qp0o91yZLk7wY9c7VHF7M&e=>
<image003.jpg>

From: Thomas Westover <000000040134e744-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:000000040134e744-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>>
Sent: Thursday, December 6, 2018 2:05 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] how to teach about cognitive bias

Does the sidm website have a list of short case presentations that are good examples of the various cognitive biases that have been reviewed in the literature ?

I would like to do a short cognitive bias review session at the beginning of our weekly M&M rounds

To teach students and residents about what these constructs are and how they are relevant in decision making

And to teach them that understanding clinical reasoning is just as important as obtaining the correct dx

Thanks

Tom

Thomas Westover MD
Sent from my iPhone

On Dec 6, 2018, at 1:04 PM, Jarrett, Mark P <MJarrett at NORTHWELL.EDU<mailto:MJarrett at NORTHWELL.EDU>> wrote:
Mark

I agree – but we often see anchoring based on the initial diagnosis that leads to less than ideal outcomes. The key to me is both a good differential (don’t always have to be right out of the gate) and purposeful reflection and re-evaluation.

Mark


Mark Jarrett, MD, MBA, MS
SVP & Chief Quality Officer
Associate Chief Medical Officer
Northwell Health
Professor of Medicine
Zucker School of Medicine at Hofstra/Northwell
(O): 516-321-6044
(C): 917-796-3935
mjarrett at northwell.edu<mailto:mjarrett at northwell.edu>



From: Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG<mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG<mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG>>
Date: Thursday, December 6, 2018 at 11:31 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [EXTERNAL] Re: [IMPROVEDX] DX measures

External Email. Use Caution.
Jason – thanks for continuing to press us all to develop practical measures we could all support that would lead to improved diagnosis.

I do agree that concordance between an admission and discharge diagnosis might be one measure of the adequacy of the diagnostic process in the ambulatory setting.  But at the end of the day, I’d argue that ‘getting it right’ is likely more important than getting it right in the clinic alone.

The agreement between admission and discharge diagnosis is fairly easy to measure and study, but this parameter is complicated !  First, in many hospitals the discharge diagnoses are assigned by coders whose primary goal seems to be centered on optimizing billing, not to capture diagnostic accuracy.  Second, and I may be old-fashioned here, but in my humble opinion there is no better time or place to make a diagnosis or to revise an initial impression.  It is so much easier to concentrate on a patient’s problems, consider and complete diagnostic evaluations, and get opinions from others during an inpatient stay compared to stretching these out over time and space in the ambulatory setting.  In this framework, any difference between the admitting and the discharge diagnosis is likely to be to the patient’s advantage and a good thing.  The disagreement noted in this study is almost certainly multifactorial, but if I had to guess, this data may be saying something positive about the diagnostic process in showing that the recorded diagnosis did in fact evolve during the admission.

    Mark

Mark L Graber, MD FACP
Chief Medical Officer; Founder and President Emeritus, SIDM
Professor Emeritus, Stony Brook University, NY


From: Jason Maude <jason.maude at ISABELHEALTHCARE.COM<mailto:jason.maude at ISABELHEALTHCARE.COM>>
Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Jason Maude <jason.maude at ISABELHEALTHCARE.COM<mailto:jason.maude at ISABELHEALTHCARE.COM>>
Date: Thursday, December 6, 2018 at 9:41 AM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] DX measures

This is a very interesting study (freely available) looking at the degree of match between the admission diagnosis and what the authors call the exit diagnosis.

“Our results show that only the 21.67% of cases are identified correctly on admission….”

Could this be used as a measure for diagnosis quality in hospitals? I am sure there will be concerns about the admitting diagnosis and clinicians being rushed to put something down without enough time but the ratio between the 2 diagnoses for an institution as a whole should be a useful indicator as would the trend over time. If the measure drove institutions to focus of getting the admitting diagnosis more accurate then that would be good.

This should also be practical to produce as would not involve the clinicians in any additional work.

In an earlier discussion, I asked if there were any measures that were practical, where there were no concerns and that we could all support but got replies. I really feel that if we are to get diagnosis the respect it deserves from hospitals and health systems then we need a measure. We have all been talking about this for a long time, but I do not sense we are any further forward!

Regards

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.isabelhealthcare.com_&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=INGksrWRy1zKL1BamDNx4gGE4MQC_2HOGsslUu-ViF0&s=ShMxvrMch6y0Y-mkw58wVE9-hhgufGxXNmOuQJa0I0w&e=>


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To learn more about SIDM visit:
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