2019 John M. Eisenberg Patient Safety and Quality Awards: An Interview with Gordon D. Schiff

摘要

We did cross paths in the early 1980s in the Society for Medical Decision Making (SMDM), one of the organizational streams that fed the nascent Society to Improve Diagnosis in Medicine (SIDM), which later hosted the early “Diagnostic Error in Medicine” conferences. I vividly recall discussing two of his little-known articles with John. These buried treasures are worth recalling because of their significance to me, as well as what I believe they represent for quality improvement (QI). The first was a 1983 article on what John dubbed “derived thresholds.” Instead of approaching so-called test-treat thresholds (how likely a disease should be for a clinician to consider ordering a diagnostic test or treatment) as something mandated from above, he showed it was possible and worthwhile to study frontline clinicians’ actual ordering practices to infer best practices (in other words, to derive the thresholds from observing practice patterns)—a very radical idea, when you think about it. The second article was his 1988 commentary titled “Clinical Scholars and Their Program: Children of the Sixties in the Eighties.” Here he traces the contribution of 1960s activism, including his own, to informing and motivating a generation of health services researchers and QI scholars.