2 articles of interest - Are more heads better than one?

Edward Winslow edbjwinslow at GMAIL.COM
Mon Mar 4 16:19:16 UTC 2019


Fascinating thread. We seem to be concentrating on radiology and path
errors.
One thing that struck me on the original paper was that the attending
physicians were not "better" than many of the juniors. That was a bit of a
surprise.
One thing that MIGHT help reduce some of the radiology load would be to
look at the indications for a study and perhaps suggest another,
potentially less controversial study to the physician who is asking for it.
This will likely NOT be welcomed by hospital administration, who get $$
from a study whether done and/or interpreted correctly. Sometimes there are
conflicts among stakeholders, and hopefully physicians and nurses could be
referees. If patients insist on a study, there might be ways to
dis-incentivize them.

Sometimes, discussing a diagnosis in a forum like "grand rounds" or a "CPC"
shows us all how others of us think and this MAY be helpful to us all.
Unfortunately, participation in conferences is, now a days, not encouraged.
It seems to take away from "productive" (RVU generating) time.  Sometimes
these activities are rewarded with CME credits, which may be needed for
organizational membership (Hosp Staff, Professional Societies, MOC), but
not always.

Might we recommend:
   1. Preview some test requests, and potentially suggest another study.
   2. Discuss in groups the diagnostic process - in those situations that
went right as well as those that didn't
   3. Try to reduce the institutional incentives to order the most
expensive/newest test or procedure, unless it has a proven track record (

Best to all.
Ted



On Mon, Mar 4, 2019 at 7:42 AM Bob Latino <blatino at reliability.com> wrote:

> Thought this may be of interest to this groupJ
>
>
>
> *Facts Don’t Change People’s Minds. Here’s What Does*
>
> https://heleo.com/facts-dont-change-peoples-minds-heres/16242/
>
>
>
>
>
> *Robert (Bob) J. Latino CEO Reliability Center, Inc.*
> 804-458-0645 (Work)
> 804-452-2119 (Fax)
> blatino at reliability.com
> www.reliability.com
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> [image: cid:image006.jpg at 01D4600C.47562910]
>
> Connect on LinkedIn <http://www.linkedin.com/in/robert-bob-latino-3411097>
>
> [image: cid:image003.jpg at 01D4600B.591F5780]
>
>
>
> *From:* Applegate, Kimberly E [mailto:keapple at UKY.EDU]
> *Sent:* Monday, March 04, 2019 6:47 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] 2 articles of interest - Are more heads better
> than one?
>
>
>
> Good afternoon,
>
> I enjoy this discussion as it brings up all the potential implementation
> science pitfalls. Yet, it is not an 'all or none' proposal to double read
> imaging in these medical professions (radiology, and also cardiology,
> dermatology, pathology). I am quite confident that we have the (be it
> artificial) intelligence to design appropriate processes that select the
> most important and problematic in our interpretative areas that will
> benefit our patients. So, why not do it?
>
>
>
> I will add that in some countries, to deal with the insufficient number of
> radiologists, they simply do not interpret (or bill for) any plain
> radiographs (Japan). That decreases the work load a great deal and they
> have one of the best WHO health and longevity ranks in the world...I would
> urge us to think out of the box.
>
> Kimberly
>
>
>
>
> ------------------------------
>
> *From:* Mark Gusack <gusackm at COMCAST.NET>
> *Sent:* Sunday, March 3, 2019 5:29 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] 2 articles of interest - Are more heads better
> than one?
>
>
>
> Good Afternoon Everyone:
>
>
>
> I agree that double reading is very valuable.  We do it all the time in
> Surgical and Cytopathology.  However, the devil is in the details.  The
> double read has to occur under circumstances that assures both do an
> independent read to avoid bias.  In addition, it has to be structured so
> the ‘ball’ isn’t dropped because each figures the other will get it if they
> don’t.  Finally, there has to be a way of resolving differences of
> ‘opinion’ that avoids confrontation and provides as means of a ‘third
> party’ expert being available to confirm one, or the other, or neither
> diagnosis.
>
>
>
> Mark Gusack, M.D.
>
> President
>
> MANX Enterprises, Ltd.
>
> 304 521-1980
>
> www.manxenterprises.com
> <https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.manxenterprises.com&data=02%7C01%7Ckeapple%40UKY.EDU%7C6c4cf3d100db4812bc3d08d6a05244a5%7C2b30530b69b64457b818481cb53d42ae%7C0%7C1%7C636872672544452373&sdata=l9h0sSMaUjEkm7e1XiNIb72J2oMQqBTcMoKGs71qSDQ%3D&reserved=0>
>
>
>
> *From:* Bruno, Michael <mbruno at PENNSTATEHEALTH.PSU.EDU>
> *Sent:* Sunday, March 3, 2019 2:55 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] 2 articles of interest - Are more heads better
> than one?
>
>
>
> Yes, that was a fantastic paper!!  I think your data suggest that the
> potential value of double reading could be as much as *12X *for error
> reduction.  I cited it on p3 of the attached paper from the December,
> 2018 issue of the journal *Radiology.*
>
>
>
> Mike
>
>
>
>
> ------------------------------
>
> *From:* Applegate, Kimberly E <keapple at UKY.EDU>
> *Sent:* Sunday, March 3, 2019 7:15 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] 2 articles of interest - Are more heads better
> than one?
>
>
>
> Thank you--in some countries double radiology interpretations are required
> (e.g., Sweden) and we might find addition evidence for value of collective
> intelligence.
>
>
>
> As one proxy measure for error,  we looked at the addenda rate in
> radiology reports and noted fewer addenda when a radiology resident had
> co-interpreted with us. Many hypothesized just the opposite. This suggests
> that 2 pair of eyes serves our patients better than one pair. AI may do the
> same to augment our abilities. Parenthetically, women radiologists were
> more likely to perform addenda than men. This leads to further social
> science questions.
>
> Kimberly Applegate, MD, MS
>
>
>
> https://www.ajronline.org/doi/pdf/10.2214/AJR.17.18339
> <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttps-3A__www.ajronline.org_doi_pdf_10.2214_AJR.17.18339%26d%3DDwMFAw%26c%3D_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0%26r%3DXZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ%26m%3DEAMFtePHzo6ZQgbZ2v0FJz3flNDZXves7yjGtviYQoE%26s%3Dyu-WCLXEYbV95mPkkhipwS-7GWgPwOQRgaQsNXUoitM%26e%3D&data=02%7C01%7Ckeapple%40UKY.EDU%7C6c4cf3d100db4812bc3d08d6a05244a5%7C2b30530b69b64457b818481cb53d42ae%7C0%7C1%7C636872672544462378&sdata=%2FT6TAllQx87xkRivgScnyGI1DxAwC%2F2HzLEGGcnuOjM%3D&reserved=0>
>
>
>
> Trainees May Add Value to Patient FOCUS ON: Care by Decreasing Addendum
> Utilization in Radiology Reports - ajronline.org
> <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttps-3A__www.ajronline.org_doi_pdf_10.2214_AJR.17.18339%26d%3DDwMFAw%26c%3D_FmMnDvUH5queZcSmOuBzHZMbp7E7EwtGwv5cxxnTj0%26r%3DXZJky8Jx0OuETXcWpBMhx9j_wSYpSZPDVXdInJ5O9gQ%26m%3DEAMFtePHzo6ZQgbZ2v0FJz3flNDZXves7yjGtviYQoE%26s%3Dyu-WCLXEYbV95mPkkhipwS-7GWgPwOQRgaQsNXUoitM%26e%3D&data=02%7C01%7Ckeapple%40UKY.EDU%7C6c4cf3d100db4812bc3d08d6a05244a5%7C2b30530b69b64457b818481cb53d42ae%7C0%7C1%7C636872672544462378&sdata=%2FT6TAllQx87xkRivgScnyGI1DxAwC%2F2HzLEGGcnuOjM%3D&reserved=0>
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> 976 AJR:209, November 2017 patient care decisions [6]. To correct or
> ex-pand on a previously finalized report, radi-ologists must generate an
> addendum to the
>
>
> ------------------------------
>
> *From:* David L Meyers <dm0015 at COMCAST.NET>
> *Sent:* Saturday, March 2, 2019 1:08 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] 2 articles of interest - Are more heads better
> than one?
>
>
>
> An interesting article and editorial comment, just published, relevant to
> improving diagnosis:
>
>
>
>
> https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2726708?guestAccessKey=1856b32c-88c6-4eda-912e-9717b95a5807&utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email
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>
>
>
>
> https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2726709?guestAccessKey=464bc45c-77b0-442b-993e-c1e91e784773&utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email
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>
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>
> David
>
> David L Meyers, MD FACEP
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> Society to Improve Diagnosis in Medicine
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
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> To learn more about SIDM visit:
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> 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:
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>
>
>
> 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:
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> 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/



-- 
*Edward B, J. Winslow, MD, MBA*
Home 847 256-2475; Mobile 847 508-1442
edbjwinslow at gmail.com
winslowmedical.com


*“...the more you know about the past, the better you are prepared for the
future.” *

Theodore Roosevelt, 26th President of United States of America






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


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