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SUBJECTS
Medical Mistakes 15% Doctor Mental Errors  Wong Diagnosis Communicat

2403 -
2403 -    ..
2404 - Summary/Objective
2405 -
240501 - Follow up ref SDS 41 0000. ref SDS 33 0000.
240502 -
240503 -
240504 -
240505 -
240506 -
240507 -
240509 -  ..
2406 -
2407 -
2408 - Progress
2409 -
240901 - An article by Doctor Jerome Groopman, ref SDS 0 U26U, in AARP magazine
240902 - September October 2008 issue explains...
240903 -                      ..
240904 -                     Why Doctors Make Mistakes
240905 -
240906 - ...reported on page 34. ref OF 1 0001
240908 -  ..
240909 - AARP article Sep Oct 2008 on page 34 says...
240911 -         ..
240912 -    1.  Too often physicians make snap decisions.  Here are three
240913 -        questions to help get you to the right diagnosis. ref OF 1 UL5F
240915 -         ..
240916 -    2.  Not long ago I spoke with a middle-aged woman whose mother had
240917 -        been misdiagnosed with Alzheimer's disease.  The elderly
240918 -        woman's memory was fading, and her family was close to
240919 -        admitting her to a nursing home. ref OF 1 5I5L
240920 -
240922 -  ..
240923 - Second Opinion Helps Doctors Avoid Mistakes Misdiagnosis
240924 -
240925 -
240926 -    3.  Luckily, the family decided to get a second opinion from a
240927 -        neurologist at a different hospital.  It turned out the woman
240928 -        did not have Alzheimer's at all  but, rather, vitamin B12
240929 -        deficiency, a well-recognized cause of dementia.  Her mild
240930 -        anemia, also due to vitamin B12 deficiency, had been written
240931 -        off by her internist as being due to "old age."  Injections
240932 -        with the vitamin fully reversed the anemia and restored her
240933 -        thinking. ref OF 1 KI6H
240935 -  ..
240936 - Kaiser's Healthwise Handbood calls for patients to get 2nd opinions to
240937 - aid primary care physician with analysis of patient history that
240938 - expands treatment for recovery, reviewed on 990625. ref SDS 24 455N
240940 -  ..
240941 - Second opinions support doctor patient partnership expands span of
240942 - attention for busy doctors, called out in Kaiser Healthwise Handbook,
240943 - reviewed 990625. ref SDS 24 4185
240945 -  ..
240946 - Millie has applied requirements on 2nd opinions to assist the doctor
240947 - as called out in the Healthwise Handbook, also listed on 990625.
240948 - ref SDS 24 PU8I
240949 -
240950 -
240952 -  ..
240953 - Misdiagnosis 15% All Patients and 7% Cause Serious Harm Due to Mistake
240954 -
240955 -
240956 - AARP article Sep Oct 2008 on page 34 says...
240957 -
240958 -    4.  Unfortunately, misdiagnosis is not a rare phenomenon.  About 15
240959 -        percent of all patients are misdiagnosed, and half of those
240960 -        face serious harm, even death, because of the error.  And,
240961 -        contrary to the general impression that misdiagnoses result
240962 -        from technical foul-ups such as mislabeled x-rays, in fact most
240963 -        cases are due to mistakes in the mind of the doctor.
240964 -        ref OF 1 007N
240966 -  ..
240967 - The report today follows up research on 990912 reporting the high cost
240968 - of medical mistakes cause injuries and death 300% greater than
240969 - automobile and airline accidents combined.  People are injured and
240970 - killed by mistakes in hospitals everyday, ref SDS 41 0001, largely due
240971 - to errors in communication. ref SDS 41 0960
240973 -  ..
240974 - Analysis on 990924 explained why doctors make mistakes, and how mental
240975 - errors can be avoided, ref SDS 43 0001, by avoiding meaning drift.
240976 - ref SDS 43 3077
240978 -  ..
240979 - On 991221 study finds that doctors do not communicate adequately with
240980 - patients 90% of the time. ref SDS 53 0001
240982 -  ..
240983 - On 040416 case study medical mistakes Millie's patient history.
240984 - ref SDS 59 GN7J
240986 -  ..
240987 - Review on 040419 cites examples of simple mistakes that occur
240988 - inadvertently, ref SDS 60 XU83, due to limited time, complexity, and
240989 - in some cases routine, repetitive tasks, where span of attention
240990 - wanders slightly. ref SDS 60 HH5G  On 041012 medical management
240991 - exasperating because staff fail to invest time for organizing the
240992 - record, causing mistakes, delay and cost escalation. ref SDS 61 NV49
240993 - On 041019 Stanford Cancer Center checks the record of documentation to
240994 - verify accuracy of patient history. ref SDS 64 OW88
240995 -
240996 -
240998 -  ..
240999 - Making Sense Complexity Pattern Recognition Wicked Problems
241000 - Accuracy Communication Analysis Critical Effective Health Care
241001 - Work Up Facilitates Accurate Diagnosis Complex Patient History
241002 - Hectic Schedule Limited Time Prevents Patient Work Up Accurate Diagnosis
241003 -
241004 -
241005 -    5.  Making an accurate diagnosis involved arranging the findings
241006 -        from physical examination and laboratory tests into a pattern.
241007 -        A doctor superimposes this pattern onto a template of the
241008 -        typical case that exists in his or her mind.  But this effort
241009 -        at pattern recognition doesn't always work.  Why not?
241010 -        ref OF 1 009M
241012 -  ..
241013 - Besides arranging findings with a template in the doctor's "mind,"
241014 - Kaiser publishes criteria for patient "work up" to aid organizing
241015 - complex patient history of examinations and tests for making accurate
241016 - diagnosis, reported on 041130. ref SDS 66 UB4H
241018 -  ..
241019 - Busy people often feel there is not enough time to implement
241020 - requirements for good management.  Requirements are interpreted as
241021 - suggestions that seem like unnecessary overkill, until someone gets
241022 - killed, then folks implement requirements for a few months until the
241023 - effects of good management become too much to bear.  Because there are
241024 - no problems using good management, good practices begin to seem like
241025 - unnecessary overkill again.
241026 -
241027 -
241029 -  ..
241030 - Patient Stress Anxiety Nervous Cannot Remember All Symptoms
241031 - People Don't Remember All Symptoms Denial Withhold Embarrassed
241032 -
241033 -
241034 -    6.  First, there may be incomplete or misleading information.
241035 -        Patients may not feel comfortable reporting all their symptoms
241036 -        to a doctor - or, as studies show, physicians may prematurely
241037 -        cut off a patient who is reciting his or her problems.  Second,
241038 -        pattern recognition is difficult because cases may not be
241039 -        "typical."  Diseases can have different manifestations,
241040 -        sometimes quite subtle, because every individual is different.
241041 -        Most significant is how the doctor selects the clinical
241042 -        elements, weighs their importance, and arranges them in his or
241043 -        her mind, a process that can result in several different
241044 -        patterns, leading to quite different diagnoses. ref OF 1 OJ8K
241046 -  ..
241047 - Big challenge of health care is empowering doctors to read the record
241048 - rather than rely on verbal expressions during hectic meetings when
241049 - everybody is under pressure and stress.
241051 -  ..
241052 - AARP article Sep Oct 2008 on page 34 says...
241054 -  ..
241055 - Communication 3 Cognitive Mistakes Anchoring Availability Attribution
241056 -
241057 -
241058 -    7.  There are three major cognitive mistakes that can occur in the
241059 -        mind of the doctor and lead to misdiagnosis. ref OF 1 006N
241061 -         ..
241062 -    8.  The first is termed "anchoring," meaning the tendency to grab
241063 -        on to the first symptom, physical finding, or laboratory
241064 -        abnormality.  Such snap judgments may be correct, but they can
241065 -        also lead physicians astray. ref OF 1 6679
241067 -         ..
241068 -    9.  A second common cognitive error is termed "availability."  This
241069 -        refers to the tendency to assume that an easily remembered
241070 -        prior experience can explain the new situation the doctor is
241071 -        trying to diagnose. ref OF 1 6685
241073 -         ..
241074 -   10.  The third mistake is thinking is termed "attribution," and this
241075 -        accounts for many of the misdiagnoses in the elderly.
241076 -        Attribution refers to the tendency to mentally invoke a
241077 -        stereotype and "attribute" symptoms to it.  Alas.  Often this
241078 -        stereotype is a negative one, such as an older person who is
241079 -        seen as a complainer, a hypochondriac, or a person unable to
241080 -        cope with his or her naturally declining abilities.  The doctor
241081 -        ignores the possibility of an illness not specifically linked
241082 -        to "old age." ref OF 1 UL4N
241083 -
241085 -  ..
241086 - Communication Tips Avoid Medical Mistakes Ask About Alterntives
241087 -
241088 -
241089 -   11.  What can a patient do to help prevent medical thinking from
241090 -        going astray?  I have formulated three simple questions to ask.
241091 -        It is quite appropriate to pose these questions to a doctor
241092 -        when he or she is making a diagnosis. ref OF 1 6695
241093 -
241094 -             1.  What else could it be?  This question helps to prevent
241095 -                 an anchoring error or an availability error, where a
241096 -                 diagnosis is formulated too quickly in the physician's
241097 -                 mind because it corresponds to the initial symptom or
241098 -                 because it is most familiar to the doctor. ref OF 1
241099 -                 6695
241101 -  ..
241102 - On 041125 AHRQ publication confirms high cost of medical mistakes
241103 - caused by communication errors offers 20 tips to reduce. ref SDS 65
241104 - SD6N  On 051103 study shows 34% of patients report experiencing medical
241105 - mistakes. ref SDS 71 ET68
241107 -  ..
241108 - Different Problems Have Common Symptoms
241109 - Knowledge Management Dilemma Wicked Problems Problems Common Symptoms
241110 -
241111 -
241112 - AARP article Sep Oct 2008 on page 34 says...
241113 -
241114 -             2.  Could two things be going on to explain my symptoms.
241115 -                 In medical school doctors are taught to be
241116 -                 parsimonious in their thinking meaning they are taught
241117 -                 to identify a single cause to explain a variety of
241118 -                 symptoms.  But sometimes a patient can have two
241119 -                 medical problems simultaneously.  Physicians sometimes
241120 -                 stop searching  once they find an initial problem,
241121 -                 even if the patient does not fully recover.
241122 -                 ref OF 1 00YX
241124 -  ..
241125 - Wicked problems present knowledge management dilemma from complex
241126 - patient history illustrated in Millie's case by work on 060722
241127 - reviewing recurrence of pulmonary embolism, which is fatal in 40% of
241128 - cases. ref SDS 74 346F
241130 -  ..
241131 - Patient History Conflicts with Diagnosis
241132 -
241133 -
241134 -             3.  Is there anything in my history, physical examination,
241135 -                 laboratory findings, or other tests that seems not to
241136 -                 fit with your working diagnosis?  All physicians tend
241137 -                 to discount information that seems to contradict their
241138 -                 hypothesis.  This bias can lead a doctor down the
241139 -                 wrong path; his or her anchor diagnosis may be so
241140 -                 firmly fixed that this leads to ignoring contradictory
241141 -                 data. ref OF 1 01PW
241143 -         ..
241144 -   12.  In some instances, these questions may cause the doctor to go
241145 -        back and reexamine assumptions, to think again, and to come up
241146 -        with a different, and now correct, diagnosis.  All doctors want
241147 -        the best treatment for their patients, and the best treatment
241148 -        involves the most open-minded thinking. ref OF 1 666H
241150 -         ..
241151 -   13.  Jerome Groopman, M.D.
241152 -
241153 -              http://www.jeromegroopman.com/bio.html
241154 -
241155 -        ...is the author of The New York Times best seller "How Doctors
241156 -        Think" (Mariner Books, 2008), ref OF 1 6744
241157 -
241158 -              http://www.jeromegroopman.com/how-doctors-think.html
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