Expert Intuition Is Often Wrong

by Hal Mooz 16. April 2014 20:10

Misdiagnosed: Docs' Mistakes Affect 12 Million a Year

t least one in every 20 adults who seeks medical care in a U.S. emergency room or community health clinic may walk away with the wrong diagnosis, according to a new analysis that estimates that 12 million Americans a year could be affected by such errors.


That means patients with conditions as varied as heart failure, pneumonia, anemia and lung cancer could have serious problems that remain unrecognized by a doctor, according to the study published Wednesday in the journal BMJ Quality and Safety.

Quantifying such errors has been difficult, largely because researchers don’t all use the same definition for mistakes and it’s hard to track cases across multiple providers over time.

What they found was that in a little more than 5 percent of cases, the original diagnosis was wrong — and could have been accurately detected by the information available in the first setting.

Previous studies had hinted that the rate of outpatient misdiagnosis might be that high, or even higher. In fact, Dr. Gordon Schiff, a patient safety expert at Brigham and Women’s Hospital in Boston, said that he believes Singh’s work probably underestimates the actual scope of diagnostic errors.

The reasons outpatient doctors miss correct diagnoses can vary widely, Singh said. Time with patients is more limited than ever and their symptoms are often complex and evaluated in what he described as "a fairly chaotic outpatient environment." Many doctors lack the support and technical help that could free them to use good clinical reasoning consistently, he added.


"This is an important finding and validates the level of safety and quality issues in outpatient settings," she said. "We know people are getting more care in outpatient settings than in the past. There needs to be more scrutiny on what they're doing and pressure to improve their performance. Misdiagnosis can have a significant impact on patient outcomes and could result in harm."


Emotional Decision With A Permanent Outcome

by Hal Mooz 16. April 2014 10:29

Denver Woman's 13-Minute-Long 911 Call Ends With Fatal Gunshot

A Denver woman who spent nearly 15 frantic minutes on the phone with a 911 dispatcher was killed Monday night by a bullet to the head before help arrived.

Kirk's husband, Richard, 47, was arrested on suspicion of first-degree murder, Lopez said. He appeared in court Wednesday, waived his formal advisement, and will remain in custody. In her call to 911, Kirk said her husband was "talking about the end of the world and he wanted her to shoot him," according to a probable cause statement filed in the case. There was a gun in their house, Kirk said at the beginning of the phone call, but it was locked in a safe.

As the call went on, Kirk told the 911 dispatcher that her husband was hallucinating, scaring their three young children, the court document said. Then, when she saw her husband had gone to the safe and gotten the gun, she started screaming. The sound of a single gunshot reverberated on the call, and Kirk wasn't heard from again.

When officers arrived, they found Kristine Kirk lying on the floor with an apparent gunshot wound to the head. She was pronounced dead at the scene. Police are investigating the possibility that Richard Kirk — who admitted to killing his wife on his way to the police station, according to the probable cause statement — took marijuana prior to the shooting.


Decision Type - Can Something Bad Happen?

by Hal Mooz 12. April 2014 09:07

The 'Rebel Heart' Parents Want To Show Their Daughters The World. The Risks Are Worth It.

My husband and I are raising a child while traveling aboard our 40-foot sailboatCeilydh. The world has two types of responses to our parenting choice: “Lucky kid!” and “That’s crazy!”

The crazy chorus is loud and angry after a fellow cruising family underwent very public rescue this past weekend. Sailors Eric and Charlotte Kaufman were sailing their vessel, the Rebel Heart, from Mexico to New Zealand with their young daughters Lyra, 1, and Cora, 3, when, 900 nautical miles from Mexico, they made an emergency call to the Coast Guard after their youngest daughter became seriously ill and the boat’s power and steering malfunctioned.

As the rescue played out in the news, with the Navy and the National Guard both stepping in, many questions were raised: Who should pay for the no-doubt costly rescue of this family? Did the Kaufmans have enough training for this big trip? And, most of all, what were they thinking taking their young daughters on such a risky adventure?

(What about the rescuers that were put at risk?)


Extreme Emotion Based Judgment

by Hal Mooz 16. March 2014 20:10

Teen father arrested for biting nose off infant

A teenage father in Northern California is under arrest after police say he bit the nose off his 1-month-old son because he was frustrated with the infant's crying. Joshua Cooper, 18, was being held Friday in the Solano County Jail on suspicion of child cruelty and aggravated mayhem, Fairfield police said in a news release.

Police said they received a call Thursday at 8 a.m. by a distraught woman who said her baby was bleeding from his nose. Doctors later determined the child suffered a skull fracture, a brain hemorrhage and that one third of the child's nose had been severed.

Police say they are still trying to determine how the skull fracture and brain hemorrhage occurred.


Solano County Chief Deputy District Attorney Terry Ray said that Cooper had not yet been charged but that she planned to charge him with child abuse and aggravated mayhem. The child-abuse charge carries a penalty of up to 12 years, and the aggravated mayhem charge carries a potential penalty of life in prison.




Tragic Perk Based Decision Judgment

by Hal Mooz 14. March 2014 09:36

Parents 'Boiling With Anger' After Daughter's Death in GM Car

Four years ago this week, Ken and Beth Melton got the phone call no parent wants to get. Their 29-year-old daughter Brooke was in a Georgia hospital with a broken neck after her Chevrolet Cobalt had spun out of control and sent her into the path of another vehicle.  

The Meltons say they’ve been in a “constant state of grief” ever since, but they’re also angry, because they say their daughter’s fatal accident was caused by a mechanical flaw that GM knew about before Brooke ever bought her car.

Brooke Melton’s 2005 Cobalt was among the 1.6 million cars GM recalled last month for problems with ignition switches. GM has now disclosed to federal regulators that it knew of problems with its ignition switches as early as 2001. But during testimony for a lawsuit that they filed against GM, the Meltons learned that the automaker had come up with a partial fix that would stop some ignition shut-off incidents, but had made a “business decision” not to implement it.

Four days before the accident, according to the Meltons. Brooke’s car had shut off while she was driving and she had lost her power steering and her brakes. She was able to pull her car over and restart it. She called her father, and he said they should take it to a dealership in the morning. Brooke got her car back from the dealership on March 9, 2010. She died in an accident the next day. “There was no doubt in my mind that it was caused by the same engine cutting off,” said Ken. The Meltons called a lawyer.

According to the Meltons, experts contacted by attorney Lance Cooper examined the “black box” from the accident and found that the key had slipped from the “on” to the “accessory” position three seconds before the accident, shutting off her power steering and power brakes. Brooke’s car had then hydroplaned on the wet highway and been struck by another car.

When the Meltons filed suit against GM, they learned via depositions from the automaker’s engineers that the company had been aware of problems before Brooke purchased her car in 2005, and had even considered a partial solution. Engineers were aware that if the key was jostled or stressed by a heavy dangling key chain it might slip and turn the car off. They proposed that GM keys be altered to make the opening for the key ring smaller and reduce jostling of the key.

Instead of changing the keys, however, GM designed an insert that could be added to the keys. It then sent a bulletin to dealer service managers that said the insert could be provided to car owners who came in and complained about ignition shut-offs. Under the program, according to GM warranty records, fewer than 500 drivers received the inserts.

During testimony, GM engineer David Trush, who helped implement the insert fix, called the insert a “good solution” for a “very small population” affected by the problem. “We put the solution out in the field,” said Trush, “the solution that would solve some of the stuff.”

Cooper, the Meltons’ attorney, asked witness Gary Altman, who was GM’s program engineering manager for the Cobalt in 2004 and 2005, if it was true that the car company “made a business decision not to fix this problem and five months later sold [Brooke Melton] a vehicle with the problem.” GM’s lawyer objected, but Altman answered, “That is what happened, yes.

 An engineer hired by the plaintiffs as an expert witness claimed in his testimony that internal GM documents showed that GM had estimated the cost per car of making the change would be less than $1.

 “It has to be money,” said Beth Melton. “It has to come down to money but that really doesn’t even make sense to me. In the end, they’re going to have to pay for it. They need to care about their customers. They need to care about human lives.”

According to GM’s figures, the defect has been linked to 12 deaths. Brooke Melton’s death is not among the deaths GM listed. “If it's caused one single death, to me that's enough,” said Ken Melton. “One single death is enough to make a recall."


Hate Emotion Based Judgment

by Hal Mooz 12. March 2014 14:47

White supremacist woman pleads guilty in Pacific Northwest killing spree

A white supremacist woman accused of killing four people during a violent road trip across the Pacific Northwest with her boyfriend pleaded guilty on Tuesday to racketeering in a deal that could send her to prison for life, federal prosecutors said.

The couple were arrested in 2011 in northern California after what authorities described as a bloody, two-week crime spree that began in the Puget Sound city of Everett, Washington, with the slayings of boyfriend David Joseph Pedersen's father and step-mother. The three-state road trip, during which the duo are accused of killing a middle-aged black man and a 19-year-old stranger singled out because they thought he was Jewish, ended with Grigsby allegedly telling police she and Pederson were on their way to "kill more Jews" in Sacramento, California.

The 24-page federal indictment says Pedersen researched the names and addresses of Jewish organizations in Seattle, Portland and Sacramento to identify "potential targets for elimination" and that he had a "draft 'press release' to alert the media about the purpose of the planned murders." The indictment describes their purpose as "promoting and advancing a white supremacist movement to 'purify' and 'preserve' the white race and 'reclaim our country.'"


Desperate Faith Based Decision Judgment

by Hal Mooz 8. March 2014 20:46

California farmers hire dowsers to find water

With California in the grips of drought, farmers throughout the state are using a mysterious and some say foolhardy tool for locating underground water: dowsers, or water witches. Practitioners of dowsing use rudimentary tools — usually copper sticks or wooden "divining rods" that resemble large wishbones — and what they describe as a natural energy to find water or minerals hidden deep underground.


 While both state and federal water scientists disapprove of dowsing, California "witchers" are busy as farmers seek to drill more groundwater wells due to the state's record drought that persists despite recent rain. "It's kind of bizarre. Scientists don't believe in it, but I do and most of the farmers in the Valley do," said Marc Mondavi, a vineyard owner whose family has been growing grapes and making wine since the mid-20th century in the Napa Valley.


While popular, scientists say dowsers are often just lucky, looking for water in places where it's already known to likely exist.

"There's no scientific basis to dowsing. If you want to go to a palm reader or a mentalist, then you're the same person who's going to go out and hire a dowser," said Tom Ballard, a hydrogeologist with Taber Consultants, a geological engineering firm based in West Sacramento. "The success is really an illusion. In most places you're going to be able to drill and find some water," he said.

Still, the consistent interest in water witches nationwide even spurred The U.S. Geological Survey to officially weigh in on the fairly harmless practice. Dowsing has not held up well under scientific scrutiny, the USGS said, adding that dowsers are often successful in areas where groundwater is abundant.


"The natural explanation of 'successful' water dowsing is that in many areas water would be hard to miss. The dowser commonly implies that the spot indicated by the rod is the only one where water could be found, but this is not necessarily true," the survey said in its report. Christopher Bonds, senior engineering geologist for the state Department of Water Resources, said his agency does not advocate using witchers.


 "DWR is an advocate for having qualified and licensed water professionals locate groundwater resources using established scientific methods," Bonds said in an email.





Trying To Overcome A Permanent Error

by Hal Mooz 26. February 2014 11:33

Paula Deen on losing 'everything': 'I'm still alive'

Paula Deen says she hopes her new business venture will help reclaim her once lucrative brand name, along with her personal reputation. "I'm fighting to get my name back,"  The celebrity cook known for her Southern dishes lost nearly all of her multimillion-dollar endorsement deals last summer after admitting in a court deposition that she had used the “n-word” in the past.

Deen later apologized through a series of YouTube videos, and an appearance on TODAY but the former “queen of butter” said she was stung by the backlash she received from people who questioned her sincerity. She said there were days last summer when she struggled to get out of bed.

Last weekend, the 67-year-old former Food Network star issued another public apology during a live cooking demonstration in Florida.

"I have heard on more than one occasion ... that I've never apologized,” she told the crowd Sunday at the South Beach Wine and Food Festival. “So if anybody did not hear me apologize, I would like to apologize to those who did not hear me."

Earlier this month, Deen announced her newly formed company, Paula Deen Ventures had secured between $75 million and $100 million of funding from private equity firm Najafi Cos. The venture will help restructure her brand of restaurants, cookbooks and food product endorsements.

"I used to have dreams that I lost everything," Deen tells People. "And when it finally happens, you think, 'I'm still alive.' "


Tragic Addiction Based Permanent Error

by Hal Mooz 24. February 2014 18:23

Dad Charged After SUV Runs Over Daughter on First-Date

A 12-year-old Pittsburgh girl who got out of her father's SUV to pose for photos with a boy following her first date was hit and killed by the vehicle, according to authorities — and her dad has been charged with drunken driving. Richard Benton, 53, refused field sobriety and breath tests at the scene of the crash at 8 p.m. Sunday, according to The Associated Press. Police said Benton's speech was slurred and he smelled of alcohol.  Harris was getting out of the Ford Explorer so that her parents could snap a picture of her and the boy when the SUV started rolling backward, according to the Tribune Review of Pittsburgh.

The SUV dragged her until it slammed into a tree and stopped — and she died at the scene, officials said. "He thought the vehicle was in park. In fact, it must have been out of gear and went over her, dragging her down the hill and then crashing into a yard,” Pittsburgh Police Sgt. Tom Huberin told local NBC affiliate WPXI.


Unfortunate and Unpleasant Fact Based Decision

by Hal Mooz 21. February 2014 12:52

Detroit Files Historic Bankruptcy Blueprint

Detroit revealed its historic plan to emerge from under $18 billion in debt Friday, laying the groundwork for what’s expected to be a long, bitter battle with creditors, retirees and bondholders over the biggest municipal bankruptcy ever.

The 120-page 'plan of adjustment' could change radically as negotiations with more than 100,000 creditors move forward. It must still be approved by U.S. Bankruptcy Judge Steven Rhodes.

A summary of the plan said it would devote $1.5 billion over 10 years to capital improvements, with up to a third of that aimed at blight removal. It also said it proposes paying general obligation creditors about 20 percent of what they are owed through the issuance of new bonds. If police and fire department retirees agree to the plan, they would receive about 90 percent of their pensions, after cutting cost of living allowances. General retirees would get about 70 percent.

The draft also detailed plans to help pensioners keep more of what they are owed by using state and private funds to protect against the sale of city-owned art at the Detroit Institute of Arts, The AP said.


About Hal Mooz

Engineer, Project Manager, Entrepreneur, Author, Trainer, Lecturer, Thought Leader, Consultant

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