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Diagnostic Error Action

  • 1.  Diagnostic Error Action

    Posted 03-22-2020 13:24

    With the Covid 19 pandemic we are in uncharted waters. But one thing is very evident and that is that a massive effort is being attempted to limit death amongst our patients. Many creative ideas are being tried and instituted across the country.

    There is little evidence since the 1999 Institute of Medicine (To Err is Human Report) that Errors in Medicine are diminishing in any way, in fact there may well have been an increase in errors and associated deaths in the intervening 21 years. 

    Are the deaths due to errors in diagnosis less or larger that those seen with the current Corona pandemic? Would estimates/comparisons between the two problems be worth undertaking?

    And if the diagnostic deaths are significant in number would this be the time for SIDM to do something bold, similar to the explosive support for patients with the Covid 19 problem?

    One of the handicaps that all medical professional organizations, have in undertaking many important ventures is what one could refer to as the LOYALTY bias. This when our loyalty to the job, our supervisors, the hospital, a medical society, etc. compromises the best support for patients.

    That needs somehow to be solved or lessened if we are ever to hope to move forward with significant programs that further help patients. The loyalty bias combined with inadequate money, lack of democratic compromise, can often lead to gridlock in any organization.

    Would changing the Board composition of medical organizations slowly over a period of time with more academics, women, patients, retired persons, etc., all helping to move the compass needle closer to the recommendations of the oaths we take as physicians?

    With the changes taking place with the Corona virus pandemic would it be possible for SIDM to undertake something a little bold in keeping with the expected creativity in medicine to come?

    What might these be?

    Some thoughts!

    ·      Simple studies that give clarification to the main diagnostic biases so far elicited, and how best to handle each of them.

    ·      Studies that evaluate the accuracy for the things we seem not do very well, particularly the patient's history and physical examination.

    ·      Surveys to identify in each medical specialty the top errors, and the best ways not to miss them. 

    ·      Close attention and contact with the Artificial Intelligence movement so as to understand and influence, if possible, what is taking place.

    ·      Etc.

    Robert M. Bell, M.D.

  • 2.  RE: Diagnostic Error Action

    Posted 03-22-2020 13:39
      And, have we adhered to the 6 aims - patient centeredness, safety, equity, timeliness, cost effectiveness, efficiency during this time? What are the trade-offs.  

     praesent superare odio  , if you can't, then - contra nando incrementum
     (rise above)                                                        (get increased swimming against the tide)

    Xavier E. Prida MD FACC FSCAI
    Assistant Professor of Medicine
    Program Director Cardiology Fellowship Training 
    Division of Cardiovascular Sciences
    2 Tampa General Circle
    STC 5 th Floor 
    Tampa, Fl 33606
    813 259 0992(O)

  • 3.  RE: Diagnostic Error Action

    Posted 03-22-2020 16:10
    Excellent Xavier and Peggy. Let's collect suggestions and then Rank them in importance for short term doability!

    Could that be done here on the list?

  • 4.  RE: Diagnostic Error Action

    Posted 03-22-2020 13:43
    I would add to this the need to let patients ACCESS and CORRECT THEIR MEDICAL RECORDS, which could be a simple as an 'Objection" by the patient as to a wrong bit of information.  In some settings, this can be handled readily, as I just did correcting my record in one office to show that I did not have a "nephrostomy" but a nephrectomy.  

    Had I known that the diagnosis of a 'small, scabbed-over stomach ulcer" from an endoscopy was clearly NOT supported by the pathology report, I would not have had as long a delay in getting my metastatic kidney cancer properly diagnosed.  Further exacerbating that life-threatening delay was the doctor's late gathering of my family history, in which I revealed that my father had been an alcoholic.  Without any discussion with me, the diagnosis was shifted to cirrhosis, which ironically led to an ultrasound showing a 10cm tumor.  Again, had I immediate access to all my records, my cancer would have been found earlier. 

    This example is not unusual, and can be corrected relatively quickly.  Just give us all the data we need immediately about what is in our medical records.  As a minimum, the patient can alert other doctors and family members as to the error, and not let that become another barrier to care.

    PS. My records still indicate that I have metastatic kidney cancer, but have been free of it for over 15 years...but those same records imply that I have cirrhosis, and infer that I am an alcoholic.
    Peggy Zuckerman