May 1, 2020
As to " the real issue that we haven't figured out"; the aviation industry tackled this years ago when aircraft crashes became unacceptable. It is done through a concept called Accommodation. For each critical fault (those that could lead to a catastrophic event), there must be fault detection and a secondary control scheme in standby, so that if the fault occurs the standby method automatically implements to avoid a catastrophic scenario. Believe it or not, these type of faults occur routinely in daily flights. You normally do not see the catastrophic effect because the backup handles the situaton until on the ground.
Requiring a DDX that is carried through to full issue confirmation, is an attempt to have a secondary strategy. This should cause some critical thinking on the part of the clinician. However, it hasn't been figured out how to "automatically" implement an observation or care plan in the event the patient takes a significant downward turn (except perhaps in the hospital setting).
Even with this excellent strategy in aviation, there is still no remedy for human mistakes that do not thoroughly investigate the fault possibilities - aka B737-800 MAX.
One way to improve the observation is to clearly identify to the patient that they are a partner in the care and must be on heightened alert. For those that have been harmed by medical mistakes or have lived a long time without the benefit of a confirmed diagnosis, I think they know the need to fully participate; however for the general population, they still depend on the clinician to fix the situation.
Ross Koppel, Ph.D. FACMI, UNIV. OF PENNSYLVANIA
Prof. of Biomedical Informatics, Perelman Sch of Medicine.
Senior Fellow, Wharton's Leonard Davis Institute of Healthcare Economics;
Senior Fellow, Center for Public Health Initiatives, Perelman Sch of Medicine;
Adjunct Professor (full) Sociology Department;
Affil Prof of Medicine, Perelman Sch of Medicine;
Prof. of Biomedical Informatics, SUNY@Buffalo