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Preference MISdiagnosis - a response to the above poi.

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Preference MISdiagnosis - a response to the above poi.

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Firstly,

Some words from:

Mulley, A. Trimble, C. & Elwyn, G. (2012). "Patient's preferences matter: stop the silent misdiagnosis". The King's Fund, London, p4.

"However, for all of the effort that the medical profession puts into getting the diagnosis right, diagnostic efforts generally proceed in ignorance of a crucial variable in the diagnostic equation: patient preferences. A better equation would be:

T = f(DM,DP)

... where DM is the medical diagnosis and DP is the preference diagnosis.
We define a preference diagnosis as a doctor’s inference of what a patient would choose if he or she were fully informed. It is an inference because no patient – save perhaps the patient who is also a doctor and world-renowned specialist
in the very disease with which he or she is afflicted  – is fully informed.
Preference diagnosis, like medical diagnosis, is often a best estimate based on imperfect information."

As a Social Worker I see this "misdiagnosis" happening frequently in the welfare, disability, community and ATOD sectors as clients preferences are (mis)interpreted by professionals with the best intentions sometimes with tragic and long-term consequences.

My experiences with the mainstream health also indicate this is happening far too often.

Of course, I also see that in a veiled effort to consider a client's or patient's preference, one will be asked about their preference after the giving of either too simplistic or too complex information. And with that inadequate information another set of problems arise leaving the client to look elsewhere or else over- or underwhelmed with the practitioner.

Note: Although the article I quote above is referenced in work by Charlesworth et al it is not the reading I intended to select so I will share another post on this board before the week is out.

Cephas

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Good work, Narelle. I remember when patients who were transferred from one facility to another (regional hospital to tertiary level, for example) would have the full range of tests repeated on arrival at the tertiary hospital, mainly because medical practitioners did not 'trust' the initial results . Sue 

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Good work, Narelle. I remember when patients who were transferred from one facility to another (regional hospital to tertiary level, for example) would have the full range of tests repeated on arrival at the tertiary hospital, mainly because medical practitioners did not 'trust' the initial results . Sue 

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I have put up a link to the White Paper by Ratnanesan (2014) which focuses on sustainability. Sue 

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I have put up a link to the White Paper by Ratnanesan (2014) which focuses on sustainability. Sue 

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Ratnanesan A, Howarth P. (2014). Future solutions in Australian healthcare –
white paper: Innovative ideas and strategies for sustainable healthcare.
Sydney: Energesse

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Interesting article and commentary, Bernie, which reflects that there is a lot of support for health and wellbeing in the community as well as in some workplaces. Yet, lifestyle-related health conditions remain so problematical. For example, obesity is a significant issue in Australia and yet we have so much access to outdoor acitivites. Why do you think these types of problems not only persist, but are increasing? However, rates of tobacco smoking have decreased and of course the government has introduced several policies which have had some good results. Can you identify some of the  policies that have impacted on  tobacco consumption and their policy 'type'? Sue

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Interesting article and commentary, Bernie, which reflects that there is a lot of support for health and wellbeing in the community as well as in some workplaces. Yet, lifestyle-related health conditions remain so problematical. For example, obesity is a significant issue in Australia and yet we have so much access to outdoor acitivites. Why do you think these types of problems not only persist, but are increasing? However, rates of tobacco smoking have decreased and of course the government has introduced several policies which have had some good results. Can you identify some of the  policies that have impacted on  tobacco consumption and their policy 'type'? Sue

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I had not heard the term before, either. Sue

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Counting Every Moment (2012) acknowledges organisations routinely use KPI’s, results accountability and goal setting for progress.  This author discusses a movement of individuals that use ‘self-tracking’ on daily activities to measure, for example, alcohol/caffeine intake, activity levels, heart rate, sleep patterns - all with the aim to improve health. The author describes users as an “eclectic mix” (techno junkies, people with health concerns, hackers, elite athletes), that share a common goal of analysing detailed ‘quantified’ knowledge.  The purpose is to track personal information, view data and then adjust personal behaviour to evaluate the effect.  Positive results included ability to increase mental alertness, lose weight, improve lung capacity and change mood. ‘Self-quantifying’ also has an acknowledged placebo effect; users are unperturbed by this (even if known) if they achieve their desired health objective. There is a variety of technological developments in this field, and the potential for wide-scale health data collection, with the added opportunity for online peer and community support models.I love the wellness focus of this modelling.  My employer provides a fitbit to wear, and sets up an online community based on measures/peer support.  My private health fund gives a benefit for increased tracked activity, and my pharmacy provides a 12 week online program with quantified personal comparative results.  In addition, I belong to an online peer support nutritional group; self-quantifying techniques are widely used here.  My adult children all use various wrist-watch and wearable technologies that track heart rate, mood, sleep and fitness training programs; they regularly load data to repositories for analysis. I am interested to realise, in our home we are already adopting this shift with some positive results.

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Counting Every Moment (2012) acknowledges organisations routinely use KPI’s, results accountability and goal setting for progress.  This author discusses a movement of individuals that use ‘self-tracking’ on daily activities to measure, for example, alcohol/caffeine intake, activity levels, heart rate, sleep patterns - all with the aim to improve health. The author describes users as an “eclectic mix” (techno junkies, people with health concerns, hackers, elite athletes), that share a common goal of analysing detailed ‘quantified’ knowledge.  The purpose is to track personal information, view data and then adjust personal behaviour to evaluate the effect.  Positive results included ability to increase mental alertness, lose weight, improve lung capacity and change mood. ‘Self-quantifying’ also has an acknowledged placebo effect; users are unperturbed by this (even if known) if they achieve their desired health objective. There is a variety of technological developments in this field, and the potential for wide-scale health data collection, with the added opportunity for online peer and community support models.I love the wellness focus of this modelling.  My employer provides a fitbit to wear, and sets up an online community based on measures/peer support.  My private health fund gives a benefit for increased tracked activity, and my pharmacy provides a 12 week online program with quantified personal comparative results.  In addition, I belong to an online peer support nutritional group; self-quantifying techniques are widely used here.  My adult children all use various wrist-watch and wearable technologies that track heart rate, mood, sleep and fitness training programs; they regularly load data to repositories for analysis. I am interested to realise, in our home we are already adopting this shift with some positive results.

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Bernie

Counting every moment (2012). The Economist, 402(8774), 20-S.22.

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Following the reading I chose to look into the article by Glasziou , Moynihan , Richards, and  Godlee. "Too much medicine; too little care (BMJ 2013; 347 f4247). I chose this as it's a topic close to my heart. 'Labels, testing and treatment' are they being overdone just to achieve potential health gains. I believe a high percentage are. There are many reasons why this may be occurring and this article starts a series of articles looking at an increase in diagnosing people with common diseases yet no increase in death rate. There being no clear criteria on how diagnosis is changed or by whom. No standards for panels  to review or to alter definition of diagnosis. The questions raised in this article are a definite issue in delivering health care in the current environment.

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Following the reading I chose to look into the article by Glasziou , Moynihan , Richards, and  Godlee. "Too much medicine; too little care (BMJ 2013; 347 f4247). I chose this as it's a topic close to my heart. 'Labels, testing and treatment' are they being overdone just to achieve potential health gains. I believe a high percentage are. There are many reasons why this may be occurring and this article starts a series of articles looking at an increase in diagnosing people with common diseases yet no increase in death rate. There being no clear criteria on how diagnosis is changed or by whom. No standards for panels  to review or to alter definition of diagnosis. The questions raised in this article are a definite issue in delivering health care in the current environment.

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Narelle

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In response to Sue's comment on 'preference misdiagnosis' I think this still occurs frequently, although i would like to think this is changing with the evolving 'new age' medical profession. I hope my own understanding of the concept (which i had never heard described this way) is correct. I am thinking about all the steps a medical officer may take in prescribing tests & investigations, even making enquiries to set up a referral, without first discussing options with a patient. In some of the tutorial work I do with medical students, i think there is demonstratable shift in the approach to involving and communicating with a patient before taking actions - it is a breath of fresh air to witness this.

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In response to Sue's comment on 'preference misdiagnosis' I think this still occurs frequently, although i would like to think this is changing with the evolving 'new age' medical profession. I hope my own understanding of the concept (which i had never heard described this way) is correct. I am thinking about all the steps a medical officer may take in prescribing tests & investigations, even making enquiries to set up a referral, without first discussing options with a patient. In some of the tutorial work I do with medical students, i think there is demonstratable shift in the approach to involving and communicating with a patient before taking actions - it is a breath of fresh air to witness this.

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Bernie

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As a point of interest here, do you think that 'preference misdiagnoses,' as described by Charlesworth et al. (p. 445) is common these days? Sue

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As a point of interest here, do you think that 'preference misdiagnoses,' as described by Charlesworth et al. (p. 445) is common these days? Sue