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Archive for the ‘dermatology’ Category

A title like “Computer bests humans in skin infection diagnosis,” is sure to get my attention.

Can computers beat doctors in actually providing medical care?  A recent study was reported as showing that “a computer program diagnosed a serious skin infection more accurately based on symptoms than emergency room physicians.”

Cellulitis is a deep skin infection that may be erroneously diagnosed in patients who have allergic or irritation reactions in their skin.  Investigators from Rochester, N.Y., and Los Angeles, Calif., evaluated  patients who were hospitalized for cellulitis by emergency room physicians. Dermatologists and infectious disease specialists found that 28 percent of the patients had been misdiagnosed and did not have cellulitis.  The admitting senior residents were asked to make a list of the possible diagnoses of these patients and to input characteristics of the patients’ conditions into a computer program that provided a computer generated list of possible diagnoses.  The investigators found that the computer listed the true diagnosis more often than did the resident physician.

The study does provide some evidence that a computer program may help some non-specialist physicians come up with a more comprehensive list of possible diagnoses than they would on their own.  The authors of the study concluded that the technology “has the potential to direct providers to more accurate diagnoses.”  They didn’t mention that having longer lists of possible diagnoses means that the technology also has the potential to direct providers to more inaccurate diagnoses, too, and that doing so could result in needless testing.

This study relied upon the expert skills of human physicians to make the gold standard judgments about whether patients had cellulitis or not.  While the computer program could help clue some doctors in to possible diagnoses they may not have considered (both accurate and inaccurate possible diagnoses), patients ultimately still depend on the good judgment of their physicians.

At DrScore, we’re excited about using digital technologies to improve medical care.  Giving doctors feedback from patients and making medical care quality more transparent are surefire ways to enhance care. But computers are not beating, besting or replacing doctors just yet.

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One of the benefits of online doctor rating — a benefit to patients and doctors — is a transparency of medical care quality that will help people identify the bad doctors, the uncaring ones, the ones who, according to some patients, you wouldn’t send your dog to. Patients aren’t the only ones who know about these doctors.  Doctors know about them too. They have seen patients who were seen by these colleagues, and all of those patients were unhappy with the care they received.

I know that online doctor rating isn’t going to find many such doctors.  In fact, quite the opposite, online rating of physicians is going to show there aren’t nearly so many “bad doctors” out there as people think there are. Let me explain.

I’m a practicing dermatologist.  I see patients who have seen another dermatologist in town, maybe a dozen or so of that doctor’s patients.  Every one of those patients was unhappy with the care they received, and none of those patients received treatment that cured their condition.

Now that’s clear evidence the other dermatologist didn’t know what they were doing, right?

No, not right.  You see, every time that other dermatologist clears up his or her patient’s rash and gives his or her patient a medical care experience the patient is happy with, that patient continues seeing the other dermatologist and doesn’t come see me.  I  see that doctor’s outliers, the occasional patient who, for whatever reason, didn’t get better or who was unhappy.  I’m sure that the other dermatologist sees a few of my former patients too, only the ones whom I didn’t cure, only the ones who were unhappy with me.  Our observations give us a misleading picture of other people.

Well what about those doctors whose patients post comments like, “I wouldn’t send my dog to that doctor?”  That kind of comment does happen, and, sadly, I’m sure that’s the true opinion of the patient who makes that comment.  But those comments are generally not anywhere close to representative of what the vast majority of that doctor’s patients think.  I get comments like that at times (thankfully less often than I used to, having learned from patient satisfaction feedback what I was doing wrong).  I’ve been rated over 500 times on DrScore.com.  The average of those scores is 9.1 out of 10 (not bad, according to my mom).  Still, occasional patients give me a 0 or a 1 for their experience.  I know they may think everyone gives me a 0 or 1, that I’m a “bad doctor,” but the great majority of my patients think I’m a 9 or 10.  So far, that’s true for all the doctors with just 10 or more ratings on DrScore.

There may be “bad doctors” out there, but I suspect they are incredibly rare.  There weren’t any in my medical school class, and I have yet to meet one in person.  If there are any, I hope we do smoke them out with online ratings.  If they exist, maybe the online scrutiny will wake them up to the need to improve the quality of care they offer.

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The FDA has announced a new program to help doctors check the approved indications and other information in drug “labels.”  These “labels” are the FDA-approved educational information sheets that drug companies package with medication. See information below:

Online Service Enables Physicians To Check FDA-Approved Medication Labeling Via EHRs.

Healthcare IT News (1/27, Merrill) reported that to “boost drug safety, a new online service has been launched that allows doctors to check the FDA -approved labeling for the most commonly prescribed drugs.” The service is part “of a new campaign” called “Know the Label,” which is being “launched in concert with the FDA’s efforts to provide up-to-date and complete prescribing information to physicians.” It is being delivered to all US physicians and providers “electronically via the websites of PDR Network, The Doctors Company and other liability carriers, via EHR systems. … ‘We congratulate The Doctors Company and PDR Network for finding a practical and novel way for physicians to access the full updated labeling through electronic means and have it available at the point of prescribing,'” said Janet Woodcock, MD, Director of FDA’s Center for Drug Evaluation and Research.

I doubt this new program to disseminate the label information is going to help patients much.  At least in my field, use of medication is based on  patients’ individual conditions and results of studies that go far beyond what’s in the FDA-approved “label.”  Medications are used for conditions other than FDA-approved uses.  Different doses are used.  Combinations that the FDA-approved label says are bad may often be exactly what a patient needs. I guess it won’t hurt to give doctors the information on FDA-approved medication labeling, unless it discourages doctors from giving patients needed treatments for unapproved conditions.

For best results, a doctor’s  good judgment is the best guide to treatment.

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“You can cite all the statistics you want but I am telling you, that a pissed off patient is about 20 times more likely to post than a happy patient!”

I hear this type of comment quite often from doctors who think doctor reviews and online doctor rating are bad things.  However, I’ve run against the current on many issues in the past.  I don’t mind doing it.  My research found that tanning beds had addictive properties years before it became conventional to think so.  My research on how poorly patients used their medicine changed a lot of thinking in dermatology about how to best treat patients.  Some doctors still don’t believe me when I tell them online doctor rating is good for patients and for doctors.

Looking at individual ratings, on a 0-10 scale where 10 is the best score, the most common score a doctor gets on DrScore.com is a 10.  The next most common score is a 9.  The average score of doctors with 20 or more ratings is OVER 9 out of 10.  It amazes me that anyone familiar with these data believes that only unhappy patients rate doctors.

I can’t say that unhappy patients aren’t more likely to rate their doctor.  What I can say is that doctors have so, so many happy patients that doctors who have 20 or more ratings have an average score of over 9 out of 10.  Doctors shouldn’t be afraid of doctor reviews and online ratings; doctors should embrace online ratings and encourage all patients to rate their doctors.  Doctors have nothing to hide. Letting the public see a representative score of how doctors are doing will help the public see what a good job U.S. doctors are doing.

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Is the placebo effect real? A closer look at the PLoS study on the benefits of placebo in treating Irritable Bowel Syndrome (IBS).

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If you have a disease or condition, join a patient advocacy group like the National Psoriasis Foundation.

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