Discussion Board

 View Only
Expand all | Collapse all

BMJ review on diagnostic reasoning in cardiology

  • 1.  BMJ review on diagnostic reasoning in cardiology

    Posted 17 days ago
      |   view attached

     

    Thanks to John Brush, Geoff Norman and Jon Sherbino for this New Year's present – a "State of the Art" review of diagnostic reasoning in Cardiology, just out this week in the BMJ, and open access to boot:

     

     

    Mark L Graber, MD FACP

    Founder and President Emeritus, SIDM

    Professor Emeritus, Stony Brook University, NY

    Work   607 305-0050

    Cell      919 667-8585

    A close up of a signDescription automatically generated

     

     

     

     

     





  • 2.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 17 days ago
    Thanks, Mark!  This is great!!!  And the price is right....


    Michael A. Bruno, M.D., M.S., F.A.C.R.  
    Professor of Radiology & Medicine

    Vice Chair for Quality & Patient Safety

    Chief, Division of Emergency Radiology

    Penn State Milton S. Hershey Medical Center
    ( (717) 531-8703  |  6 (717) 531-5737

    * mbruno@pennstatehealth.psu.edu  

    1571679014277





  • 3.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 17 days ago
    Thanks for sharing this great article. I have a question for the members of this group. The Abstract starts, "Research in cognitive psychology shows that expert clinicians make a medical diagnosis through a two step process of hypothesis generation and hypothesis testing. Experts generate a list of possible diagnoses quickly and intuitively, drawing on previous experience. " 

    In my experience working with many patients (and in my family's personal experience), diagnostic errors often happen because the provider does not have the patient's condition in their experience and thus does not consider it as a hypothesis. This may be because it is a rare disease or because the provider simply hasn't seen it recently or ever. 
    Does the field accept that hypotheses should be based on the provider's experience (including education)?
    Is there no step where the provider does something to consider conditions that do not immediately come to mind?
    Thanks,
    Megan Golden


    Megan Golden, CEO


    Sent via mgolden@mission-cure.org" target="_blank">Superhuman






  • 4.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 17 days ago
    This is precisely the place for differential diagnosis decision support systems: DXplain, with which I work, Isabel and others.
    No one can (or should be expected to) know the clinical features of every disease in the world.  Yes, most doctors should get a hypothesis when the disease is common and the findings typical, but rare disease do exist, and common diseases may have atypical findings.

    ------------------------------
    Edward Hoffer
    Massachusetts General Hospital
    ------------------------------



  • 5.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 17 days ago

    The most interesting aspect of this, to me, is exactly this question of how much we can\should learn about 'expert' diagnosis when in reality most diagnosis is tackled by non-experts.  I accept the argument that true experts would receive very little benefit from software that helps with differential diagnosis; they already know the variants and the rare\exotic diseases that might be responsible for a patient's condition.  But for everyone else, decision support seems like an excellent way to mention diagnoses that didn't initially spring to mind.  There are other solutions as well – consults, and second opinions are at the top of the list along with decision support.






  • 6.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 17 days ago
    Mark,
    Happy New Year!  Our experience, when we look at our user data @VisualDx we see that experts also use diagnostic CDS.  I've been a dermatologist for 27 years and I know my brain has limited capacity.  I often blank on rare genodermatoses and the 1 in a million diagnoses I learned about during residency but also tis unusual variants of the common are a van large part of dx error.    
    As an example, Dr Mathis in Lisa Sanders NYT column this past weekend (link below) used point of care information as part of his diagnostic process and he is a specialist. 
    Best
    Art





  • 7.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 16 days ago
    Is there anyway that the advances taking place in diagnostic Artificial IntelligenceI can be extrapolated into practice to improve diagnosis today?

    Would regional differential diagnoses improve things?

    Robert Bell, M.D.







  • 8.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 16 days ago
    Hello
    AI may help improve diagnostic accuracy, however I fear it may actually worsen it for some populations. The AI algorithms are only as good as the underlying data they are based on. In many cases this data does not include under represented populations. Therefore they algorithms perform well for the populations of patients they were based on but perform very poorly in the under represented populations.

    Ted E. Palen, PhD, MD
    Colorado Permanente Medical Group
    Sent from my iPhone
    NOTICE TO RECIPIENT: If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents. If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them. v.173.295 Thank you.




  • 9.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 16 days ago
    In radiology, the major equipment vendors (Siemens, GE) are now investing heavily in developing workable AI products to add on to their equipment, as well as commiting to support research to demonstrate the value of these AI tools.  So there is growing momentum in the "AI" space for improving diagnosis at the testing level, at least as regards to image interpretation.  

    The leading national radiologic society, the Radiological Society of North America (RSNA) has launched a journal entirely devoted to Radiology artificial intelligence research.  There are a LOT of research papers!


    All the best,

    Mike

    820 Jorie Blvd., Suite 200 Oak Brook, IL 60523-2251 U.S. & Canada: 1-877-776-2636 Outside U.S. & Canada: 1-630-571-7873
    pubs.rsna.org


    Michael A. Bruno, M.D., M.S., F.A.C.R.  
    Professor of Radiology & Medicine

    Vice Chair for Quality & Patient Safety

    Chief, Division of Emergency Radiology

    Penn State Milton S. Hershey Medical Center
    ( (717) 531-8703  |  6 (717) 531-5737

    * mbruno@pennstatehealth.psu.edu  

    1571679014277





  • 10.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 16 days ago
    H Michael,

    Thanks, important information.

    Do you think it could be valuable to discuss AI issues here on the Discussion Board. Could it help the developers?

    Rob Bell







  • 11.  RE: BMJ review on diagnostic reasoning in cardiology

    Posted 16 days ago
    Could regional diagnostic differential diagnosis be used to compensate for any inequalities?

    Rob Bell, M.D.