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Dr Gordon Caldwell Profile picture
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Feb 8 • 7 tweets • 7 min read
Misdiagnosis and Cognitive Overload in the Clinical Workplace causing Morbidity and Mortality. Look at the notes pages in this PowerPoint. 10 Quality Indicators for Clinical Consultations

dropbox.com/s/niz0e1h1hc7k…

@HumanRiskLtd @nialldowney @TheIHI @AndrewElder @cuttingforstone
How to create conditions for Misdiagnosis that can kill or seriously harms patients.

#PulmonaryEmbolism

#AddisonsDisease

and Counter Measures

#DiagnosticCockpit dropbox.com/s/qkbpmcxe85b0…
Time is the Great Diagnostician

We must intervene before the patient dies
A sense of hurry enlarges our diagnostic blindspot

@Bonniecomm @nialldowney
Interruptions are one of the most effective ways to undermine high level thinking ... resulting in #Misdiagnosis
Quality Indicators for Clinical Consultations, How to Reduce Harmful Misdiagnosis

dropbox.com/s/niz0e1h1hc7k…
10 Quality Indicators for Clinical Consultations

Continuous improvement would reduce #Misdiagnosis, over-investigation, incorrect treatments.

But Clinicians are pressured to see more & more patients in same time without system improvement

dropbox.com/s/vd7fybw50ml9…

@OpsProf

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More from @doctorcaldwell

Dr Gordon Caldwell Profile picture
Feb 7
Just now
Right now
@CarolynFahm feels like April today
Read 4 tweets
Dr Gordon Caldwell Profile picture
Feb 7
humanriskpodcast.com/dr-gordon-cald…

We need to Run Faster than Diseases Progress in Patients.

So much #NHS Hospitals can do to unblock A&E & Wards without waiting for more Social Care - #CutTheCrap

@mnt @BBCr4today @BBCNews @TheIHI
youtube.com/live/Z8Kkg20G7… for those who prefer video to podcast - starts at 12:04pm #NHS Drowning in Paperwork
@DrGrumble @rakeshspatel

Not to mention

#Policies
#Guidelines
#email
#Datix
#MandatoryTraining
#Appraisal
#Revalidation
#ePortfolios
#Committees
#Governance

No wonder there are queues of patients everywhere in #NHS

Doctors want to Doctor
Nurses want to Nurse
Read 6 tweets
Dr Gordon Caldwell Profile picture
Jun 21, 2021
It’s interesting I’m being told how long is ideal in #NHS for Clinical Consultations in Outpatients by ‘management’, who can hold as many meetings of undefined purpose and length as they wish at short notice & expect my participation @djnicholl @PeteGordon68 @vincentconnolly
The most important Meetings in #Healthcare are between Patient and Clinician but are not the ones valued and prioritised by management

dropbox.com/s/vd7fybw50ml9…
Imagine if management’s meetings were subject to same rules as outpatients?
Schedule 6 weeks in advance
New Agenda items 30 mins max, Reviews 15 mins. Extra items can be added by anyone but all items must still be discussed. Items for other meetings can be added in Willy Nilly
Read 13 tweets
Dr Gordon Caldwell Profile picture
Jun 19, 2021
I don’t think of myself as a great doctor but I know there is no success in medicine without preparation and organisation therefore I have just spent 2hours organising our inpatients medical case note folders after today’s #WardRounds @DrGrumble @CLOSLER @j59dd
I don’t know what had happened in the 3 weeks since my last Physician of the Week but someone must have decided that entropy into chaos was the best way to organise inpatient clinical notes and won everyone over. Entropy is easy, organisation is unremitting hard work
I cannot do #WardRounds nor #Outpatients without knowing who the patient is as a fellow human being and without Problems Lists but many contemporaries seem happy without either. I follow #LarryWeed @VisualDx @writer_samshem
Read 7 tweets
Dr Gordon Caldwell Profile picture
Nov 17, 2019
Yes, that’s what I trained for too

I weep watching our Junior Doctors wrangling with dreadful disconnected paper & computer IT which gobbles up their working time & undermines their Clinical Reasoning thus putting Diagnosis & Patient Management at risk
At a ‘Winter Pressures’ meeting on Friday I said we could make our already good 4hr performance an hour better if we had Usable IT and cut out the quintuplication of information into multiple different bad paper & computer IT systems @acutemedicine @PeteGordon68 @nhshBoyd
I type Discharge Summaries using the horrible #NHSHighland #IDL software but it has to be something really really important to persuade me to use Hospital version of #SCIGateway for inter hospital referrals - retyping name address GP into badly designed IT. Intensely frustrating
Read 4 tweets
Dr Gordon Caldwell Profile picture
Mar 9, 2019
#DNACPR or Will For The Final Stages of Dying?

dropbox.com/s/7ybniuov566r…

I observe that every Consultant struggles with DNACPR because of the negative framing. We (I?) must change the framing

@JohnLauner
Consultants & Juniors at #FortWilliam like this

You are not dying now
Your health is frail
One day your health will deteriorate badly and
We will know you are dying and
What should we do for you then?

Patient usually answers

Let me go, Doc

dropbox.com/s/7ybniuov566r…
Then we have to say

Sounds like you said

Me, #IWantAPeacefulDeath?

Then in this crazy UK culture you need a Red #DNACPR Licence for a Peaceful Death

‘Oh no, Doc, I’m not going to be #DNACPR’

We must reframe the whole ‘Near End of Life’ conversation @JohnLauner @TheIHI
Read 12 tweets

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