Bad Outcomes of Questionable Medical Decisions

Letters18 March 2003Bad Outcomes of Questionable Medical DecisionsTimothy P. Hofer, MD, MS and Rodney A. Hayward, MDTimothy P. Hofer, MD, MSVA Center for Practice Management and Outcomes Research; Ann Arbor, MI 48113 (Hofer, Hayward)Search for more papers by this author and Rodney A. Hayward, MDVA Center for Practice Management and Outcomes Research; Ann Arbor, MI 48113 (Hofer, Hayward)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-6-200303180-00029 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Kessler argues that in the patient we discussed, a more conservative approach to managing pericardial effusion would have been preferable. The cardiologist in this case (who was also a respected clinician at a respected institution) made a different decision. Our experience in formal studies of physician peer review suggests that reviewers make highly variable assessments in most episodes of patient care (1). Assessments of clinical decision making are not very precise, although there is evidence that they are valid in that they correlate with other measures of quality (2). Dr. Kessler also suggests that errors should be ...References1. Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001;286:415-20. [PMID: 11466119] CrossrefMedlineGoogle Scholar2. Rubenstein LV, Kahn KL, Reinisch EJ, Sherwood MJ, Rogers WH, Kamberg C, et al. . Changes in quality of care for five diseases measured by implicit review, 1981 to 1986. JAMA. 1990;264:1974-9. [PMID: 2214062] CrossrefMedlineGoogle Scholar3. Hofer TP, Kerr EA, Hayward RA. What is an error? Eff Clin Pract. 2000;3:261-9. [PMID: 11151522] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Timothy P. Hofer, MD, MS; Rodney A. Hayward, MDAffiliations: VA Center for Practice Management and Outcomes Research; Ann Arbor, MI 48113 (Hofer, Hayward) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAre Bad Outcomes from Questionable Clinical Decisions Preventable Medical Errors? A Case of Cascade Iatrogenesis Timothy P. Hofer and Rodney A. Hayward Bad Outcomes of Questionable Medical Decisions Kenneth M. Kessler Bad Outcomes of Questionable Medical Decisions Elizabeth Nilson Bad Outcomes of Questionable Medical Decisions William B. Weeks and James P. Bagian Metrics Cited byA Comparison of Total Hip and Knee Replacement in Specialty and General Hospitals 18 March 2003Volume 138, Issue 6 Page: 520 Keywords Adverse events Decision making Extrapolation Hip Patients Peer review Safety Safety studies ePublished: 18 March 2003 Issue Published: 18 March 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...