Exam 3 Flashcards
Diagnostic Errors are _____
Diagnostic errors are the leading type of paid medical malpractice claim
Most people will experience at least one diagnostic error in their lifetime
Clinical Decision Making
Doctors must heal and serve diagnosis
Polyamory Diagnosis
Pre commit to diagnosis then undergo all relevant information to find actual diagnosis
The 5 Common Diagnostic Errors
Anchoring Bias Confirmation Bias Prevalence Bias Outcome Bias Availability Bias
Anchoring Bias
Rendering diagnosis based on things patients say on first two to 3 sentences –> bassically commit to pre diagnosis
Confirmation Bias
Confirm diseases you have instead of treat.
Thus confirming hypothesis/ pre diagnosis instead of seeking evidence that might disprove it.
Search Satisficing
Uses information from previous diagnosis to fix a person –> differ from confirmative since doctors are fixing the issue at hand
Calling off search for other abnormalities (bc found satisfaction in first diagnosis –> similar to confirmative diagnosis
Availability Bias
what is available in your head based on intuitions on the world
Ex) Covid is more available in our head thus we have more intuition if you have a runny nose now then you have a bacterial infection –> this will happen because you just diagnosis –> Which leads to error
Prevalence Bias
The tendency to misjudge the true base rate of a disease
Ex) If you physician treats breast cancer your physician is more than likely to believe you have breast cancer
Outcome bias
The expectation to do something
Ex) Preference of an action –> to eliminate cancer is to have surgery –> does not think about the outcome if there weren’t an outcome –> because doctors are known to to heal, diagnosis, and treat
Results of Availability Bias
Confidence increases the more you diagnosis and the longer you been a doctor
Renne Fox: more experience you have the less likely you are to diagnosis heavily creating conjugative bias –> more confidence in second year medical residents then first year medical residents
Second year residents have more errors than first year residents because they tend to form the availability bias
When was there a sharp drop in life expectancy
Sharp drop in life expectancy due to flu pandemic –> 1980
In men world war 2 during –> 1940-50 soldiers died
Idea of: Crisis Morality –> sharp declines in morality
The Standard of Living Debate
Argument 1: Standard of living as the causal engine
Argument 2: Purposeful action as the causal engine
Argument 1: Standard of living as the causal engine is
If we improve developing countries ECONOMY than improve life expectancy and standard of living
Ex) Incomes improved, which lead to an improved diet
Market is beneficent
Argument 2: Purposeful action as the causal engine is
Its not just economy its about general health knowledge –> gains a educated population
market is not beneficent
The McKeown Thesis
The growth of population can be attributed to a decline in mortality from infectious diseases by turning into chronic dieases
Fixing Morality
Decline in organism virulence (harmfulness of diseases)
Immunization
Urban hygiene improvements
(1-3 –> neg findings don’t work)
Nutritional improvements –> improving in standard of living and economy to improve diet –> postive finding but hard to provde
Sweden vs Kazahkstan
The death rate in 1992: Sweden: 10.55 per 1,000 Longer life expectancy Lower fertility More older age groups Kazahkstan: 7.42 per 1,000 Far more younger people and infants due to higher fertility Thus longer life expectancy
But the age-specific mortality rate in Kazahkstan is higher for every age group thus this is NOT a paradox
Tuberculosis
Specific medical innovations mattered little
Improvements started well before municipal hygiene became important definitely wasn’t medicine that dropped the morality rate
Thus disagrees with Mckowen thesis
In wales (England) Tuberculosis was main disease
When does Medicine Matter
When it takes most of the morality
–> Vaccines are helpful and drop mortality rates but wasn’t needed to drop rates –> SO yes medicine matters but not always used to drop rates In morality
Diet & Height
Height is responsive to nutritional improvements but increase in height is only weakly correlated with increases in life expectancy
The Preston Curve: the improvement in life expectancy is driven by two factors which are ____
GDP
Technological change –> productively controlling a disease –> is sort of like the mckeown thesis
***Sweden has really good
records in morality :D
Lower fertility in Sweden more older people thus their is more older problems than baby problems like cancer over puberty
–> Thus as morality increase birthrate decrease
Urban-Rural Differences
You are better living on a farm then in a urban area
People move to city where deficit is the greatest which have lower life expectancy but its good for the economy
The Importance of Institutions and Knowledge
Controlling disease requires new institutions –> that the economy cannot always do
Shifting focus from external causes (e.g., God) to internal ones (e.g., how I prepare my food)
In absence of this, everyone suffers
External Vs Internal
Shifting focus from external causes (e.g., God) to internal ones (e.g., how I prepare my food)
The Epidemiological Transition
In progressing from HIGH to LOW mortality, all populations experience a shift in the major causes of illness (of death).
These changes are associated with socioeconomic improvements—as total mortality declines and income rises, communicable disease mortality declines
The Epidemiological Transition shift from
Infectious disease to Chronic Diseases
Ex) Nutritional and Reproductive health to degenerative and Man made diseases
Four Transitions –> Of how disease became chronic
External injuries to infectious disease –> Larger Populations, in urbans areas and long periods in the same location
Infectious to degenerative disease Unpredictable
–> population ages
Cardiovascular to cancer –> diet and overall health improves
Cancer to something else Mystery
- Overall decline in cancer mortality
Morality Vs Mortality
Morality –> People Infected
Mortality –> Peopled killed
Women vs Men
Women Outlive men –> especially in older ages but females have higher probability of death at low life expectancy levels because they are susceptible to infection.
Shown alot in japan
Caveats of shifting causes of death very fast
Deviations in PACE –> Some developing countries have yet to fully move through them
Deviations from linear and unidirectional change
Some reverse transitions ex) chronic to infectious
The 5 Models of Doctor Patient Relationship
Instrumental Paternalistic Informative Interpretive Deliberative
Instrumental model →
patient values are irrelevant – physicians acts on patients only as an instrument of science (cruelty)
Paternalistic Model →
Patient values are objective thus pshs yasin convinces the patent to do something
Informative Model →
Convinced gap between doctor and patient thus, patient is not safetied and does not know how to make a good decision and rather feels pressure – emphasis on knowledge of medicine is hard to quire and physician must care as much as they inform
Intervention model →
Patient values are conflicted thus, phsyains is of authority to persuade patients into doing certain treatments but must not over power
Deliberate model →
think of as an discussion, there is a balancing between choice and biased information, discussing alternate and different treatments – more confidence however than the interpretive model – most consistent with the public expectations of physicians
