“Diagnosis, Treatment, and Prevention of Errors in Dermatology Practice” (Session F055) will assist dermatologists in adopting evidence-based strategies for holding medical errors to a minimum. The Saturday, March 22, session will feature error-reduction action steps presented by Eliot N. Mostow, MD, MPH, and Stephen Helms, MD.
“We aren’t in a position like baseball players of settling for a .300 to .400 batting average, which is a 30 to 40 percent batting success rate,” said Dr. Mostow, professor and chair of dermatology, Northeast Ohio Medical School, Rootstown, Ohio, and assistant professor of dermatology, Case Western Reserve University School of Medicine, Cleveland. “We are held to a higher standard, and we should be, but still we have to be focused enough to realize that diagnostic and treatment errors can and do occur.”
The presenters’ approaches to reducing errors are grounded in peer-reviewed studies from the medicine and business worlds, particularly the airline industry. This research has demonstrated the effectiveness of developing checklists, avoiding decision-making pitfalls, and maintaining continuous quality improvement processes.
“Checklists ensure that you don’t drop the ball on anything,” Dr. Mostow said. “As much as we like to think that we have perfect memories and we do things the same all the time, the truth is that certain things are better off done with checklists. Unfortunately, many times these occur when we least expect them because of seemingly minor steps that are simply skipped or thought performed by someone else on the team.”
For example, some dermatologists might forget one time out of 10 to ask a patient for whom they want to prescribe a biologic drug about a history of congestive heart failure or neurologic symptoms of multiple sclerosis. Forgetting salient details could be dangerous, or even deadly, to the patient. One process for circumventing that rare instance of forgetting is the checklist.
As for decision-making pitfalls in diagnosis and treatment, Dr. Helms will draw insights from the book, How Doctors Think, by Jerome Groopman, MD. Dr. Helms is professor of dermatology at the University of Mississippi Medical Center, Jackson, Miss. Those insights cover how ways of thinking, no matter how well intended, can lead to diagnostic errors. For example, a physician treats many patients who tend to have a specific condition. For that doctor, every time a patient presents with similar findings, it may appear to point to that one condition when that may not be the case at all.
Additionally, physicians can only determine a diagnosis based on the scientific information of what they can remember. What if a condition is outside that physician’s medical information memory bank? New technology goes a long way in expanding that medical information base and in assisting physicians to consider other various diagnoses, he said. Decision-support analysis software has shown promise in reducing potential diagnostic errors, improving diagnostic accuracy, and assisting in therapeutic decisions.
“These decision-making diagnostic and treatment errors are actually thought to be a huge issue in all of medicine,” Dr. Mostow said. “For us as physicians, a certain amount of humility goes a long way in trying to make sure we don’t miss more rare diagnoses.”
Error prevention also requires ongoing work with interactive processes — continuous quality improvement. “It’s structurally planning an approach to a problem, taking actions, measuring whether those make a difference, and setting up a cycle, or system, of continuous quality improvement in the practice,” Dr. Mostow said. “The fact is that it is not a finite all or nothing deal. The practice of medicine is always evolving.”
The goal in presenting the session, he said, is for dermatologists attending the session to take real ideas for improvement back to their practices.
“We hope they realize the specific action they can take in their practice to improve their diagnosis and treatment and to prevent errors,” Dr. Mostow. “It’s that reminder to think outside the box and discover an area where they might make a difference in their practice and patient outcomes.”