[EXTERNAL] Re: [IMPROVEDX] DX measures

Lyn Behnke lynbehnke at GMAIL.COM
Tue Jan 29 16:02:01 UTC 2019


I have done that for years and the reason is exactly what you mentioned.  A beloved mentor who was both a physician and attorney told me to do that because if I fall over dead tomorrow, the next person can pick up my note, see what I saw, know what I was thinking and continue in the process or change the plan.  This was when the focus was on a longitudinal relationship in primary care.

 

From: Seiji Hayashi <seiji.hayashi at NPC.HUMANDX.ORG>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Seiji Hayashi <seiji.hayashi at NPC.HUMANDX.ORG>
Date: Tuesday, January 29, 2019 at 10:41 AM
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] [EXTERNAL] Re: [IMPROVEDX] DX measures

 

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

 

 



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--

The Human Diagnosis Project.

One open system.

For all of humankind.

Together.

 

--

The Human Diagnosis Project.

One open system.

For all of humankind.

Together.

 



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


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