Oct 25, 2012 AHD
08:00-09:00 PGY 1 Tut TR #4 Reardon Toxicology
08:00-09:00 PO 1-4 TR #1 Hebert n/a
08:00-09:00 PO 5 TR #2 n/a n/a
08:00-09:00 EMUS Exm SM EM Rm
08:15-08:45 RCR Conf. Rm M-197 Vakani n/a
09:00-10:00 GR Amphitheatre Newman-Toker
10:00-13:00 COMBINED Conf. Rm M-197 Newman-Toker Neuro:
1330:-16:30 CC Sim Sim Centre Weitzman, Miller
08:00-09:00 PO 1-4 TR #1 Hebert n/a
08:00-09:00 PO 5 TR #2 n/a n/a
08:00-09:00 EMUS Exm SM EM Rm
08:15-08:45 RCR Conf. Rm M-197 Vakani n/a
09:00-10:00 GR Amphitheatre Newman-Toker
10:00-13:00 COMBINED Conf. Rm M-197 Newman-Toker Neuro:
1330:-16:30 CC Sim Sim Centre Weitzman, Miller
Objectives & Reading
Please see below for October 25th AHD objectives with Guest Speaker Dr. Newman-Toker to share with the group.
Diagnostic Errors: State of the Science Overview
ABSTRACT
Misdiagnosis is a major public health problem. Diagnostic errors account for an estimated 40-80,000 deaths annually in US hospitals alone. A similar number of diagnostic errors likely result in preventable, serious, permanent morbidity. Tort claims for diagnostic errors are nearly twice as common as claims for medication errors and result in the largest payouts. Diagnostic errors result in more than $2 billion in paid malpractice claims annually in the US, and lead to the practice of defensive medicine, estimated to cost tens of billions more in unnecessary diagnostic tests per year. The science of misdiagnosis is underdeveloped. To date, research on misdiagnosis has mainly emphasized developing error classifications, assessing cognitive pitfalls, and measuring the effect of education or decision support on diagnostic accuracy in written cases. In practice, misdiagnoses often go unrecognized or unreported, and the science of measuring their frequency and impact has not been firmly established. In this lecture, we will review the current state of the science in understanding diagnostic failures, emphasizing current controversies, recent insights, and gaps to be filled by future research. We will discuss conceptual models, definitions, epidemiology and burden, and suspected root causes for diagnostic errors. We will describe a clinical context-based framework for diagnostic error that might facilitate the development of solutions. We will consider various systems-oriented solutions to prevent diagnostic errors, examine their likely strengths and weaknesses, and illustrate a mechanism for testing their economic viability. Finally, we will explore likely challenges and pitfalls facing the diagnostic safety and quality movement.
Learning Objectives:
ABSTRACT
In this session we will take an interactive, case-based approach to systematically step through the diagnostic process in patients with dizziness or other neurologic symptoms.
Learning Objectives:
Message from Dr. Newman-Toker:
I generally prefer to run my presentations off my own laptop if I can, because the videos are less likely to malfunction… so if that is possible for your AV folks, that would be great.
The other thing is to make sure the residents have a few cases ready for the case unknowns session. Probably a good idea to have 4 “unknown” cases ready; we may only cover 3, but it is best to have a ‘spare’ just in case one of the others is not well suited to the discussion format. The residents don’t need to do a whole lot of preparation --- just have enough familiarity with the case (or case notes available) that they can answer key questions about the clinical presentation. These should be cases they’ve seen with neurologic symptom presentations (dizziness, headaches, numbness, weakness, gait disorder, double vision, etc.) but they need not be patients with neurologic illness (it could be general medical causes, ocular causes, ear causes, etc.). The cases are best if the patient presented with one or two key symptoms of initially unknown cause and the diagnosis is ultimately discovered (the audience prefers if there is an “answer” even though the education happens around the diagnostic approach to the case, rather than the answer, per se). It is better if the patient presented with a symptom, rather than a sign (e.g., “3rd nerve palsy” or “coma” or “epistaxis”). The cases are less useful if the cause is already known or highly suspected at the time the patient presents (e.g., patient with hydrocephalus and shunt in place who presents with headache from shunt malfunction; patient who presents with headache and progressive loss of unconsciousness after a head trauma resulting in skull fracture). And there is no need for the cases to be due to strange or rare causes --- the most instructive cases are ones where there is a slightly atypical presentation of a reasonably common cause, particularly something dangerous (or where something dangerous is under consideration and it turns out to be benign). It is best if only one or two of the residents are already familiar with each case, so the others can approach the problem as if it were a true unknown case.
See you soon!
Best,
David
David E. Newman-Toker, MD, PhD
Associate Professor, Department of Neurology
Johns Hopkins Hospital, Meyer 8-154; 600 North Wolfe Street, Baltimore, MD 21287
Diagnostic Errors: State of the Science Overview
ABSTRACT
Misdiagnosis is a major public health problem. Diagnostic errors account for an estimated 40-80,000 deaths annually in US hospitals alone. A similar number of diagnostic errors likely result in preventable, serious, permanent morbidity. Tort claims for diagnostic errors are nearly twice as common as claims for medication errors and result in the largest payouts. Diagnostic errors result in more than $2 billion in paid malpractice claims annually in the US, and lead to the practice of defensive medicine, estimated to cost tens of billions more in unnecessary diagnostic tests per year. The science of misdiagnosis is underdeveloped. To date, research on misdiagnosis has mainly emphasized developing error classifications, assessing cognitive pitfalls, and measuring the effect of education or decision support on diagnostic accuracy in written cases. In practice, misdiagnoses often go unrecognized or unreported, and the science of measuring their frequency and impact has not been firmly established. In this lecture, we will review the current state of the science in understanding diagnostic failures, emphasizing current controversies, recent insights, and gaps to be filled by future research. We will discuss conceptual models, definitions, epidemiology and burden, and suspected root causes for diagnostic errors. We will describe a clinical context-based framework for diagnostic error that might facilitate the development of solutions. We will consider various systems-oriented solutions to prevent diagnostic errors, examine their likely strengths and weaknesses, and illustrate a mechanism for testing their economic viability. Finally, we will explore likely challenges and pitfalls facing the diagnostic safety and quality movement.
Learning Objectives:
- Define diagnostic error and misdiagnosis-related harm
- List causes and possible solutions
- Classify diagnostic errors in a systems solution-oriented framework
- Prioritize targets for error reduction
ABSTRACT
In this session we will take an interactive, case-based approach to systematically step through the diagnostic process in patients with dizziness or other neurologic symptoms.
Learning Objectives:
- Generate an appropriate differential diagnosis for acute neurologic symptoms based on bedside clinical features.
- Identify key historical dimensions and physical examination signs that help differentiate dangerous from benign causes of common neurologic symptoms.
Message from Dr. Newman-Toker:
I generally prefer to run my presentations off my own laptop if I can, because the videos are less likely to malfunction… so if that is possible for your AV folks, that would be great.
The other thing is to make sure the residents have a few cases ready for the case unknowns session. Probably a good idea to have 4 “unknown” cases ready; we may only cover 3, but it is best to have a ‘spare’ just in case one of the others is not well suited to the discussion format. The residents don’t need to do a whole lot of preparation --- just have enough familiarity with the case (or case notes available) that they can answer key questions about the clinical presentation. These should be cases they’ve seen with neurologic symptom presentations (dizziness, headaches, numbness, weakness, gait disorder, double vision, etc.) but they need not be patients with neurologic illness (it could be general medical causes, ocular causes, ear causes, etc.). The cases are best if the patient presented with one or two key symptoms of initially unknown cause and the diagnosis is ultimately discovered (the audience prefers if there is an “answer” even though the education happens around the diagnostic approach to the case, rather than the answer, per se). It is better if the patient presented with a symptom, rather than a sign (e.g., “3rd nerve palsy” or “coma” or “epistaxis”). The cases are less useful if the cause is already known or highly suspected at the time the patient presents (e.g., patient with hydrocephalus and shunt in place who presents with headache from shunt malfunction; patient who presents with headache and progressive loss of unconsciousness after a head trauma resulting in skull fracture). And there is no need for the cases to be due to strange or rare causes --- the most instructive cases are ones where there is a slightly atypical presentation of a reasonably common cause, particularly something dangerous (or where something dangerous is under consideration and it turns out to be benign). It is best if only one or two of the residents are already familiar with each case, so the others can approach the problem as if it were a true unknown case.
See you soon!
Best,
David
David E. Newman-Toker, MD, PhD
Associate Professor, Department of Neurology
Johns Hopkins Hospital, Meyer 8-154; 600 North Wolfe Street, Baltimore, MD 21287
