Posts Tagged ‘dermatology’

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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I received an email from the National Psoriasis Foundation about some of their recent accomplishments.

If you or a family member have a chronic illness, consider joining a patient advocacy group.  You can learn about diseases, find out about new treatments or even help support research toward a cure.  You can find a comprehensive  list of patient advocacy groups on DrScore.com.

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American ingenuity at work!  My friend, dermatologist Rhett Drugge, was a pioneer in the use of the Internet in dermatology.  Then he devoted himself to a better way to check patients’ moles, developing the Melanoscan, a total-body skin imaging system using a multi-camera photo booth to capture whole body photography. 

Rhett’s work is helping detect skin cancers earlier, potentially saving lives. It’s one thing to come up with a great idea — Rhett has gone much further in making the technology a reality and bringing it to commercialization.  Kudos!

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Reuters reported that the drug company Novartis has developed a chip-in-pill technology that can record when patients take their medication.  This is amazing and, well, a little bit chilling.  The idea in this case is to help make sure people who have had a transplant take the immunosuppressive medication they need to assure that they don’t reject the transplanted organ.

Poor use of medication is way too common.  Much of my research has been on how poorly patients with skin disease use their medicine and what can be done to help patients use their medications better.

Chips-in-pills that are activated by stomach acid is an interesting, “Star Wars” approach that could appeal to some people. And it shows the efforts that the health care system has to go to in order to get patients to use their medications well — which highlights the extent of this intractable problem.

But one  thing that I have found in my research is that making sure patients are satisfied with their care and trusting of their doctors — through the use of patient satisfaction feedback like we do at DrScore.com — is one of the (low-cost) ways to improve medication use.   I’m pretty sure that we could help improve patients’ care more by helping them better use available, low cost medications than by developing new, high cost medications and taking the Star Wars approach to making sure they use it.

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One of the great joys of medicine is seeing patients get better. One of the greatest frustrations is seeing patients not improve as expected with treatment.

One of the biggest problems in medicine — one that causes patients to suffer and that increases the cost of care — is that patients don’t take their medications as recommended.

A research group in Massachusetts studied how well patients with eczema take their medications and whether text messages could increase patients’ use of the medicine.  The researchers found that the text messages did increase patients’ use of the prescribed treatment.

People can improve the effectiveness of our health care system just by doing a better job taking their medications.  Hopefully, the new, inexpensive electronic technologies can help patients do that.

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As I sit here with my MacBook Air on my lap, reading about this week’s news and blogging on it, a story on toasted skin syndrome arrived.  Based on a publication that just came out in the journal Pediatrics, the article describes a 12-year-old child who developed heat-induced changes in the skin caused by chronic exposure to a laptop computer.

Changes in the skin due to chronic heat exposure are well known, often occurring from chronic use of a heating pad or exposure to a wood stove or fireplace.

OK, here’s a reality check:

  • First, the news reports about how this can precipitate future skin cancer are probably more than a bit overblown. In the great majority of cases of this condition, all that happens is a color change in the skin.
  • Second, at least based on my personal experience, you can have a laptop on your lap for a long, long time before this condition will occur.  Just move it around a bit or position it so that the heat doesn’t build up in one spot for too long.

If you want to see an example of skin changes due to heat and learn a bit more about this problem, read Dr. Jeff Benabio’s post at The Derm Blog. Dr. Benabio, an expert on the use of social media and medicine, was a guest recently on the Getting Better Health Care radio program.

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A new study was published in the Canadian Medical Association Journal comparing three common wart treatments: freezing, over-the-counter salicylic acid, and (my favorite) watch-and-wait.

Of these treatments, freezing the warts every two weeks was the most effective.

Unfortunately, most patients failed to respond in all three groups.  It would be nice to have a safe, painless and effective wart treatment.  I hope the pharmaceutical industry is listening!

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I don’t do much cosmetic work myself, but many dermatologists do.  Every few years I go to a lecture to hear a cosmetic dermatologist describe what’s new.  Every time I do,  I am amazed at the scientific progress, the new procedures, and new drugs and technologies that are available.

I went to a lecture by Dr. Gilly Munavalli, a wonderful dermatologist who practices in Charlotte, N.C. Dr. Munavalli has had extraordinary educational experiences.  Like so many other great physicians, he is devoted to his craft.  His lecture was outstanding, covering new developments in laser treatments, new fillers to counteract aging, treatments to eliminate fat deposits and other modern miracles.

Like anything else in medicine, if you’ve been thinking about having something done, see a physician.  They may have new and better things to offer than ever before.

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Blogs, Twitter, Facebook … what does it all mean for medical care? I explore this topic with Dr. Jeff Benabio on Getting Better Health Care.

Jeff is a long time friend, a dermatologist in Southern California and a frequent user of social media.  He and I explore how social media can, will and shouldn’t be used in medicine.  You can follow Dr. Jeff’s blog at thedermblog.  Follow him on Twitter (@dermdoc) at http://twitter.com/dermdoc.

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CBS News reports that 30 percent of Botox injections (an injection of botulinum toxin designed to paralyze muscles that cause wrinkles) are to people under the age of 30. Don’t our young people have better things to do? Instead of an injection, a better way to look good and to feel good is to do some volunteer work.

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