Perhaps a controversial headline but a study recently appeared in JAMA (Journal of the American Medical Association) ‘Physicians' diagnostic accuracy, confidence and resource requests which revealed some rather shocking figures about the levels of physicians’ diagnostic accuracy, confidence and the contribution to diagnostic accuracy made by lab tests and imaging.
Isabel Healthcare Blog
“Old GP” is an actual GP based in North America who is close to retirement. He has a keen interest in strange presentations of diagnoses and a wealth of experience. He has been using Isabel over the last few months and has gone back over some memorable old cases to see whether and how Isabel could have helped. We thought that his experiences would be of great use and interest to other clinicians, not only to hear about these cases but also how Isabel could have helped in building the differential diagnosis. “Old GP” wishes to remain anonymous out of respect for the privacy of patients and colleagues.
A landmark article published yesterday in “JAMA Internal Medicine” entitled “Types and Origins of Diagnostic Errors in Primary Care Settings” once again highlights the importance and value of traditional clinical skills and the differential diagnosis.
The study looked at 190 cases of diagnostic error highlighted by triggers within the medical record such as unexpected return visits etc. rather than malpractice suits. The settings were two large sites each with a list size of around 50,000 patients-one was public health (Veterans Administration) and the other an integrated private healthcare system. The key points from the paper for us were:
DDX tools could help to avoid diagnosis errors in the ICU
The idea for the Isabel diagnosis support tool first came to us while sitting in the ICU. A decade ago, my family and I were spending long hours in the ICU caring for our toddler, Isabel Maude, after she was diagnosed late with necrotising fasciitis. We realized the ICU doctors often can see the long perspective of what happened to a patient, as they see how the patient got there and what mistakes were made along the way. With the luxury of hindsight they can see, for example, that if only a clinician had, metaphorically, turned left instead of right then the patient would not have ended up in ICU.
About the Isabel Diagnosis Challenge
The New England Journal of Medicine (NEJM) publishes interesting presentations of common diseases and unusual cases in the Clinical pathology Conference (CPC) series. These cases are educational and can pose diagnostic challenges even to the expert physicians at the Massachusetts General Hospital.
An independent study on diagnosis decision support tools in medical education recently conducted by the Children’s National Medical Center and The George Washington University School of Medicine in Washington, DC, investigated these areas:
Excerpt from John Gomez, CEO of JGo Labs "Leadership Cheat Sheet for HIT Executives" from HISTalk 1/11/12
As we start the new year, we resolve to achieve improvements in all we do, including our medical practices and patient diagnosis efforts.
Whether the debate is at the national healthcare reform level or down at the level of a specific episode of care for a certain patient, a large part of the discussion about how to deal with the many ills of the US healthcare situation has focused on cutting back on benefits or care covered and/or requiring patients to pay more for their care. In this discussion we have paid much less attention to a third broad, equally or even more important approach – improving the way we deliver care or improving the productivity of our clinical delivery systems.
Rosalind Franklin University of Medicine and Science (RFUMS) in North Chicago, Illinois has used the Isabel Healthcare diagnosis decision support tool as part of its medical curriculum since 2007. The Chicago Medical School at RFUMS offers a doctor of medicine graduating 190 students each year and is a national leader in inter-professional medical and healthcare education.