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Redelmeier D.A.,University of Toronto | Redelmeier D.A.,Sunnybrook Health science Center | Redelmeier D.A.,Institute for Clinical Evaluative science in Ontario | Redelmeier D.A.,Sunnybrook Research Institute | Dickinson V.M.,Institute for Clinical Evaluative science in Ontario
Journal of General Internal Medicine | Year: 2011

Human perception is fallible and may lead patients to be inaccurate when judging whether their symptoms are improving with treatment. This article provides a narrative review of studies in psychology that describe misconceptions related to a patient's comprehension, recall, evaluation and expression. The specific misconceptions include the power of suggestion (placebo effects), desire for peace-of-mind (cognitive dissonance reduction), inconsistent standards (loss aversion), a flawed sense of time (duration neglect), limited perception (measurement error), declining sensitivity (Weber's law), an eagerness to please (social desirability bias), and subtle affirmation (personal control). An awareness of specific pitfalls might help clinicians avoid some mistakes when providing follow-up and interpreting changes in patient symptoms. © 2011 Society of General Internal Medicine. Source


Redelmeier D.A.,University of Toronto | Redelmeier D.A.,Sunnybrook Research Institute | Redelmeier D.A.,Institute for Clinical Evaluative science in Ontario | Redelmeier D.A.,Center for Leading Injury Prevention Practice Education and Research | And 2 more authors.
Journal of General Internal Medicine | Year: 2012

Fallible human judgment may lead clinicians to make mistakes when assessing whether a patient is improving following treatment. This article provides a narrative review of selected studies in psychology that describe errors that potentially apply when a physician assesses a patient's response to treatment. Comprehension may be distorted by subjective preconceptions (lack of double blinding). Recall may fail through memory lapses (unwanted forgetfulness) and tacit assumptions (automatic imputation). Evaluations may be further compromised due to the effects of random chance (regression to the mean). Expression may be swayed by unjustified overconfidence following conformist groupthink (group polarization). An awareness of these five pitfalls may help clinicians avoid some errors in medical care when determining whether a patient is improving. © Society of General Internal Medicine 2012. Source


Redelmeier D.A.,University of Toronto | Redelmeier D.A.,Sunnybrook Research Institute | Redelmeier D.A.,Institute for Clinical Evaluative science in Ontario | Redelmeier D.A.,Sunnybrook Health science Center | And 3 more authors.
Journal of General Internal Medicine | Year: 2013

The purpose of this review is to describe ten potential pitfalls for practicing clinicians who use smartphones during active patient care (Textbox). These devices are an integral element of modern medical care and will certainly endure for the years ahead; hence, a listing of latent caveats does not nullify their many advantages toward efficient medical care. An awareness of specific pitfalls might help clinicians harness more of the benefits and avoid some of the problems. This list may also help guide future engineering research that seeks to mitigate problems with current smartphones. The toughest problems to solve are the ones you don't know you have and the ones that your predecessors never encountered. © 2013 Society of General Internal Medicine. Source


Moss J.H.,University of Toronto | Redelmeier D.A.,University of Toronto | Redelmeier D.A.,Sunnybrook Research Institute | Redelmeier D.A.,Institute for Clinical Evaluative science in Ontario
General Hospital Psychiatry | Year: 2010

Objective: Psychiatric inpatients may be detained against their will, yet they still retain the right to apply for a hearing to challenge this detention. We tested whether adjudicated decisions over whether to uphold or rescind the detention have implications in subsequent patient morbidity. Methods: Consecutive patients applying to the Consent and Capacity Board in Ontario between January 1, 2004, and March 31, 2007, were identified who had a hearing to challenge their involuntary detention. Population based databases provided information on subsequent deaths, hospitalization for a psychiatric illness, or emergency department visit for any reason. Results: A total of 3498 decisions were rendered for 2321 unique psychiatric patients during the 39 month study period. Almost all patients (90%) had a prior psychiatric admission. Approximately 18% of involuntary detentions were rescinded with subsequent outcomes showing a greater likelihood of emergency department visits within 100 days of discharge in the group whose detention was rescinded compared to the group whose detention was upheld (46% vs. 36%, P=.003). Conclusions: When an involuntary detention is rescinded patients have a high likelihood of subsequent utilization of emergency department services for suicide related symptoms but no large increase in risk of dying. © 2010 Elsevier Inc. All rights reserved. Source


Ackery A.D.,University of Toronto | McLellan B.A.,University of Toronto | McLellan B.A.,Sunnybrook Health science Center | Redelmeier D.A.,University of Toronto | And 3 more authors.
Injury Prevention | Year: 2012

Objectives Bicycling is a popular means of transportation that is sometimes associated with injury from collisions. The authors analysed national data for the USA to evaluate bicyclist deaths associated with motor vehicle impacts. Methods The authors conducted a population-based caseecontrol analysis of road deaths reported by the National Highway Traffic Safety Administration. The authors included bicyclist deaths from 1 January 2008 to 31 December 2008 (cases), along with the non-bicyclist road deaths immediately before and after the bicyclist death in the same state (controls). Analyses also included linkages to auto appraisal websites to estimate type, size and cost of the motor vehicle involved in each death. Results A total of 711 bicyclist deaths were included, equivalent to a rate of 2 deaths per million population annually. No state had a rate statistically significantly below the national average whereas Florida was a high outlier with three times the national rate (p<0.001). The typical bicyclist who died was a man travelling in the afternoon or evening. The average estimated resale value of the involved motor vehicle was about one-third higher for bicyclist deaths than control deaths (US$10 603 vs US$8118, p<0.001). Analyses based on median estimated resale value and luxury resale value yielded similar findings. Stratified analyses based on demographics, time and posted speed limits yielded similar discrepancies. Larger motor vehicles were particularly common in bicyclist deaths compared to control deaths, especially freight trucks (11% vs 8%, p=0.008) and large automobiles (43% vs 37%, p=0.004). Conversely, motorcycles were distinctly infrequent in bicyclist deaths compared to control deaths (1% vs 14%, p<0.001). Conclusions Large expensive motor vehicles account for a disproportionate share of bicyclist deaths. Bicyclists, motorists, policy-makers and vehicle manufacturers need to consider more imaginative solutions to help prevent future deaths. Source

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