Achieving Diagnosis by Consensus

Abstract

This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.

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Notes

  1. 1.

    Chest radiograph, or chest X-ray, is an examination of the chest using X-rays. It is a routine investigation in patients with query of lung or heart disease.

  2. 2.

    Computed tomography, is a computer analysis of a series of X-ray pictures which allows a three-dimensional construction to be made from the series.

  3. 3.

    Positron emission technology is a specialised imaging technique that uses short-lived radioactive substances (radioisotopes) to produce three-dimensional coloured images of those substances functioning in the body.

  4. 4.

    F-18 fluorodeoxyglucose activity on positron emission tomography. FDG is a radioactive sugar and the most common radioisotope used in PET scanning.

  5. 5.

    Positive Predictive Value.

  6. 6.

    Metastases represent secondary cancer deposits that have travelled a distance from the primary cancer site via lymph or blood channels.

  7. 7.

    Histopathology is the branch of pathology that studies disease changes at tissue structure level.

  8. 8.

    One packet of cigarettes per day for a year is defined as a ‘1 pack year’.

  9. 9.

    Picture Archive and Communication System.

  10. 10.

    TTF-1 is an immunochemical cell marker that is usually positive in lung (as well as some other) tumour cells.

  11. 11.

    ‘met’ is used here as short for metastases.

  12. 12.

    Ziehl–Neelson method to colour mycobacteria with fuschin dye.

  13. 13.

    Digital Imaging and Communications in Medicine.

  14. 14.

    Picture Archive and Communication System.

  15. 15.

    The cut edge of the tissue removed at operation is called the surgical margin.

  16. 16.

    Method to obtain a tissue sample for pathology, that is less invasive than surgical biopsy.

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Acknowledgements

Our thanks to Dr. Finbarr O’Connell and all the members of the multidisciplinary team at the respiratory MDTM in St James’s Hospital, Dublin, for their co-operation in this on-going study. We also thank Dr. Nicholson for use of the photographs, and the anonymous reviewers for this paper for their constructive comments. The cooperation of the Division of Radiation Therapy, Trinity College Medical School, is gratefully acknowledged. This research is supported by funding by the SFI Research Frontiers grant under the National Development Plan.

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Correspondence to Bridget Kane.

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Kane, B., Luz, S. Achieving Diagnosis by Consensus. Comput Supported Coop Work 18, 357–392 (2009). https://doi.org/10.1007/s10606-009-9094-y

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Key words

  • diagnosis
  • ethnography
  • healthcare
  • interaction analysis
  • medical diagnosis
  • multidisciplinary medical team meetings
  • technology
  • teleconference