[EXTERNAL] Re: [IMPROVEDX] DX measures

Seiji Hayashi seiji.hayashi at NPC.HUMANDX.ORG
Tue Jan 29 13:47:48 UTC 2019


I've been writing my differential diagnosis in the notes section of the
Assessment to help my thinking as well as those who may read it later. It's
my form of doing a "diagnostic time out" to make sure I'm not missing
anything. Some have argued that this increases liability, but after talking
with physicians and those in liability, considering something but ruling it
out is less of a risk because you thought about it and acted in the best
interest of the patient (even if you were wrong). This removes the argument
that you were negligent, and a peer reviewer may agree that the thought
process is reasonable.

In addition, if your practice routinely shares medical records with
patients, this differential enables the patient to understand the care
process better.

I'm sure others have their own experiences.
ᐧ

On Mon, Jan 28, 2019 at 11:36 PM Peter Loa <peterloa at gmail.com> wrote:

> Maybe this discussion about differential is problematic.
> This NEJM article argues that we should be moving towards writing
> hypothesis into the notes (pdf also attached) -
> https://www.nejm.org/doi/pdf/10.1056/NEJMp1606402
> I know I would be uncomfortable writing only hypothesis in the case notes
> but maybe after writing down the primary diagnosis, other differentials
> could be written as hypotheses?
>
> Has anyone actually seen hypothesis written in the notes?
> What could be the problems in you see?
>
> Peter
> Med ed reg - Mackay
>
> On Mon, 10 Dec 2018 at 03:30, Jarrett, Mark P <MJarrett at northwell.edu>
> wrote:
>
>> It is not about a grade or being right or wrong. The problem centers
>> around critical thinking and reassessment. It is true that the ED diagnosis
>> is very symptom based. These symptoms are still important as test data
>> returns. What is needed is an iterative process that incorporates new
>> information but does not reflect earlier information. My comment on natural
>> language processing was centered on using the documented critical thinking
>> by the ED physician to assess if their differential diagnosis was
>> appropriate, the admitting physician also reevaluated and subsequent
>> providers reassessed. My fear is that checklist rich EHR has  suppressed
>> what was on paper in the past (but not often enough).
>>
>>
>>
>> Mark
>>
>>
>>
>>
>>
>> Mark P. Jarrett, MD, MBA, MS
>>
>> SVP & Chief Quality Officer
>>
>> Associate Chief Medical Officer
>>
>> Northwell Health
>>
>> Professor of Medicine
>>
>> Zucker School of Medicine at Hofstra/Northwell
>>
>> (P) 516-321-6044
>>
>> (C) 917-796-3935
>>
>> mjarrett at northwell.edu
>>
>>
>>
>>
>>
>>
>>
>> *From: *"Sanders, Lisa" <lisa.sanders at YALE.EDU>
>> *Reply-To: *Society to Improve Diagnosis in Medicine <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Sanders, Lisa" <
>> lisa.sanders at YALE.EDU>
>> *Date: *Saturday, December 8, 2018 at 2:38 PM
>> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> *Subject: *[EXTERNAL] Re: [IMPROVEDX] DX measures
>>
>>
>>
>> *External Email. Use Caution.*
>>
>> Emergency physicians make the admitting diagnosis. That’s how they are
>> admitted but not necessarily what the doctors caring for them think.
>> Perhaps the admission H and P should be the start point. I’m not sure that
>> ER physicians or medicine should be graded on the admitting dx.
>>
>>
>>
>> *From:* Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
>> *Sent:* Thursday, December 06, 2018 6:07 AM
>> *To:* 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=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.isabelhealthcare.com-252F-26data-3D02-257C01-257Clisa.sanders-2540yale.edu-257Cfe876ee781744f85d84b08d65b88f4cd-257Cdd8cbebb21394df8b4114e3e87abeb5c-257C0-257C0-257C636797042785465062-26sdata-3D3gJPfS8jaQ6gcksJ6aiQFQ5i1hEa5QuWv0Q-252FnSoMC8c-253D-26reserved-3D0&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=KrqXFh0vaNpp4vZ8XEFV9Lih-dNw56ru69LkUUOirJg&s=w-Onp_UODys-R1hL9PainIePsDFSuTiCV2ByuxO1yr4&e=>
>>
>>
>>
>>
>> ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> <https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Flist.improvediagnosis.org-252Fscripts-252Fwa-2DIMPDIAG.exe-253FSUBED1-253DIMPROVEDX-2526A-253D1-26data-3D02-257C01-257Clisa.sanders-2540yale.edu-257Cfe876ee781744f85d84b08d65b88f4cd-257Cdd8cbebb21394df8b4114e3e87abeb5c-257C0-257C0-257C636797042785465062-26sdata-3DSsseqWwk7n-252Fi56EyOOhcZ2-252Bi91pR-252F0Wn-252BvKpoxSDM8E-253D-26reserved-3D0&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=KrqXFh0vaNpp4vZ8XEFV9Lih-dNw56ru69LkUUOirJg&s=6oZXI2KBTx16HYpCNQPP3uiYoPaUy2GT0J_cCyrxkQE&e=>
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FINDEX&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=KrqXFh0vaNpp4vZ8XEFV9Lih-dNw56ru69LkUUOirJg&s=RQKT1tjlwgGMxoGZMUbLge5TJuMSPnEHeuJuc34JN5M&e=>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=KrqXFh0vaNpp4vZ8XEFV9Lih-dNw56ru69LkUUOirJg&s=VDUNK86qCBIOaG-O5LV4aGYLqWIhbt2eGerNouHc0oM&e=>
>>
>>
>> ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> <https://urldefense.proofpoint.com/v2/url?u=http-3A__list.improvediagnosis.org_scripts_wa-2DIMPDIAG.exe-3FSUBED1-3DIMPROVEDX-26A-3D1&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=KrqXFh0vaNpp4vZ8XEFV9Lih-dNw56ru69LkUUOirJg&s=BJ4ji8ONkAh9CfNVEj9Xu4q9OGB3e0AMVNTbzd7uzzI&e=>
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>> The information contained in this electronic e-mail transmission and any
>> attachments are intended only for the use of the individual or entity to
>> whom or to which it is addressed, and may contain information that is
>> privileged, confidential and exempt from disclosure under applicable law.
>> If the reader of this communication is not the intended recipient, or the
>> employee or agent responsible for delivering this communication to the
>> intended recipient, you are hereby notified that any dissemination,
>> distribution, copying or disclosure of this communication and any
>> attachment is strictly prohibited. If you have received this transmission
>> in error, please notify the sender immediately by telephone and electronic
>> mail, and delete the original communication and any attachment from any
>> computer, server or other electronic recording or storage device or medium.
>> Receipt by anyone other than the intended recipient is not a waiver of any
>> attorney-client, physician-patient or other privilege.
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> --
> The Human Diagnosis Project.
> One open system.
> For all of humankind.
> Together.
>

-- 
--
The Human Diagnosis Project.
One open system.
For all of humankind.

Together.






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20190129/b881222b/attachment.html>


More information about the Test mailing list