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I don’t know why I’m in the hospital! Patient-doctor diagnostic concordance Zackary Berger, MD, PhD Assistant Professor Johns Hopkins General Internal Medicine
Doctors and patients think differently.
Doctor-patient diagnostic concordance ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Ripped from the Bellevue Hospital casefiles: The real story of Ms. D ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Doctor-patient communication in the hospital ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Diagnostic concordance: a previous study (Tisnado 2006) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Diagnostic discordance among medicine inpatients: specific aims ,[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Diagnostic discordance among medicine inpatients: hypotheses ,[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Study design, setting, and population ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Patient interview ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Medical record abstraction ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
How do we define EMR-patient diagnostic concordance? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Patient characteristics (N=46) ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
“ No sé porque estoy en hospital” ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Diagnostic discordance ,[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Discordance is greater among older patients Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant (N, %) Discordant (N, %) Age  >=  60 Age  <  60 5 (17%) 18 (83%) 11 (48%) 12 (52%) 30 (65%) Total 16 (35%)
Discordant patients are less educated Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant Discordant Mean years of  schooling (SD) 10.6 (4.4) 8.9 (4.7)
Summary ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Limitations ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Future questions ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
How do we address the problem of diagnostic discordance? ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
Make way for Diagnostic Reconciliation!

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I don’t know why I’m in the hospital! Patient-Doctor Diagnostic Concordance by Berger

  • 1. I don’t know why I’m in the hospital! Patient-doctor diagnostic concordance Zackary Berger, MD, PhD Assistant Professor Johns Hopkins General Internal Medicine
  • 2. Doctors and patients think differently.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16. Discordance is greater among older patients Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant (N, %) Discordant (N, %) Age >= 60 Age < 60 5 (17%) 18 (83%) 11 (48%) 12 (52%) 30 (65%) Total 16 (35%)
  • 17. Discordant patients are less educated Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant Discordant Mean years of schooling (SD) 10.6 (4.4) 8.9 (4.7)
  • 18.
  • 19.
  • 20.
  • 21. Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH
  • 22.
  • 23. Make way for Diagnostic Reconciliation!