“I appreciated the article on cognitive biases and diagnostic error by Mull et al in the November 2015 issue. They presented an excellent description of the pitfalls of diagnosis as reflected in a case of a patient misdiagnosed with heart failure who ultimately died of pulmonary tuberculosis complicated by pulmonary embolism (the latter possibly from using the wrong form of heparin). To the points they raised, I would like to add a few of my own about diagnosis in general and heart failure in particular.
First, any initial diagnosis not confirmed objectively within the first 24 hours should be questioned, and other possibilities should be investigated. I have found this to be essential for every day’s stay in the hospital and for every outpatient visit. The authors mention checklists as part of the solution to the problem of misdiagnosis, and I would suggest that confirmation of initial diagnoses be built into these checklists …
Second, it is good to look at things yourself, including the patient, medication lists, laboratory values, and radiographic films …
Additionally, I have found that ordering several days’ laboratory tests (eg, complete blood cell counts, chemistry panels) in advance, in many cases, risks missing important findings and wastes time, energy, and the patient’s blood. I have learned to evaluate each patient daily and to order the most pertinent laboratory tests …”
The foregoing excerpt from a Letter to the Editor entitled “Cognitive bias and diagnostic error” by Morton H. Field, MD, in the June, 2016, edition of Cleveland Clinic Journal of Medicine (Vol. 83, No. 6: 407-408) implies clearly the need for IT-enabled clinical cognitive support to improve the chances of correct diagnosis under the complex and chaotic conditions typical of healthcare venues.
Please validate this proposition to your own satisfaction by reading the white paper; or by viewing a presentation.that describes the background, purpose and scope of CHARTSaaS©; or by viewing a presentation that describes how SMEs can use CHARTSaaS© to create a mobile app for handoff communication mistake mitigation. CHARTSaaS©-built apps can mitigate medical mistakes (currently the third leading cause of patient deaths in the USA, per Makary and Daniel); thereby minimizing patient adverse events and optimizing clinical case outcomes while maximizing the cost-effectiveness of care and treatment and also accelerating the accrual and facilitating the application of medical knowledge. Please contact me, Pete Melrose, at jpetermelrose@gmail.com or +1 (612) 201-2301 to discuss and decide re how you or your organization can participate in development completion and launch of CHARTSaaS©. Patient lives may depend on your decision. Thanks for your consideration and hopefully your support, and good wishes for another great day!