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

Gerrit Jager gerrit.jager at PLANET.NL
Mon Mar 4 23:56:07 UTC 2019


Dear all,

I too enjoy this discussion. I agree with most of Kimberly, Michael  and
with Lenny with whom I discussed this a long time ago.

But I would like to add something: In the first place there are certain
groups of patients who will benefit by double reading. I think of patients
referred by the family physician.
But there is another point I like to make, Four eyes may I hope prevent the
psychological damage to the patients when he become aware that an obvious
mass (ŒI could see it myself¹) is missed and the devastating effect it has
for the reporting radiologist who is in fact the Œseccond victim¹.
And although an obvious miss may be considered as an Œexcusable neglect¹
https://pdfs.semanticscholar.org/3735/136a9d08e7aa033ef48d0d63c996b7af5b53.p
df 
I think most radiologist will never excuse themselves for missing obvious
diagnosis that kills the patients.

Attached my own translation (we call it stone coal English) of some excerpts
of an article I wrote for Dutch Society of Radiology  in which a plead for
double reading (A mass of 4 cm missed on a chest X-ray, published with
permission of the patient, who wanted us to learn and improve.) Most
radiologist I spoke agreed but nothing changed until now.

Sincerely 

Gerrit 




Op 04-03-19 12:46, Applegate, Kimberly E <keapple at UKY.EDU> schreef:

> 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 Œball¹ isn¹t
> dropped because each figures the other will get it if they don¹t.  Finally,
> there has to be a way of resolving differences of Œopinion¹ that avoids
> confrontation and provides as means of a Œthird party¹ 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
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> aUjEkm7e1XiNIb72J2oMQqBTcMoKGs71qSDQ%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.p
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> yGI1DxAwC%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.p
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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?guestAcce
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> 
>  
> 
> https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2726709?guestAcce
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>  
> 
>  
> 
> David
> 
> David L Meyers, MD FACEP
> 
> Society to Improve Diagnosis in Medicine
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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