Posts Tagged ‘doctors’

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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A very nice blog post described the difficulty in getting some doctors to recognize the importance of measuring patients’ satisfaction.  The blog post differentiated patient satisfaction from “clinical quality.”

While the blog post was right on the mark in many ways, differentiating patient satisfaction from quality of care may be a mistake.  Patient satisfaction is a critical dimension of the quality of medical care.  Sure, making the right diagnosis and prescribing the right treatment are essential elements of good medical care, but patient satisfaction is an essential element as well.  To achieve great medical care, patients must feel cared for.  The way to find out if that’s being achieved is to ask them.

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Pissed off patients aren’t the only ones who rate doctors — happy ones do, too.

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Medicine is a science, but it is also a highly personal experience.

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I noticed on the back of a banker’s business card it said:

“Reliable, responsive, empathtic and competent service.”

We docs are trained to give competent service: the right diagnosis, the right medicine and skilled surgery.  But like the customers in a bank, our patients also deserve our attention to reliability, responsiveness and empathy.

Yes, medicine is a science, but it is also a highly personal experience.

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Economist Gerald Epstein found that economists who have been advising government have had financial ties to the entities about which they had been giving advice.  Sounds a bit seedy. He found that one prominent economist had written a supportive paper about Iceland’s economy — funded by the Icelandic Chamber of Commerce — shortly before that economy tanked (the economist responded at this site.

Epstein didn’t claim there were abuses; he just pointed out that it would be good to have some ethical guidelines in place, particularly disclosure of financial ties and more transparency, just as we are seeing in medicine today.  Here, here!  Transparency is good for all concerned, something we strongly believe in at DrScore.com.

One of the best points Epstein made is that he didn’t believe that economists should cut off ties with industry.  Those ties could be important, just as in medicine it is valuable for drug companies, government agencies, academic centers and doctors to work together to develop and disseminate new treatments (something discussed on Getting Better Health Care a few months ago).  But ties should be transparent, so that patients can made informed decisions.

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NPR reports that Congressman John Mica has been pushing to replace TSA airport screening employees with screeners from private companies, and that those companies have been major contributors to Congressman Mica.  Maybe replacing TSA employees with private screeners is a good idea, maybe it isn’t.  But do we trust the opinion of a Congressman who is taking money from the companies that would benefit from this policy?  Doesn’t that money make us question his judgment on this issue?

The reason I ask has nothing to do with airport screening.  The doubt that I feel when I hear this Congressman pushing policies that help the people who give him money makes we wonder if this is how some patients feel about the advice they get from their doctor — knowing the doctor received money for services provided to drug companies.

There are growing regulations at many levels on the relationship between health care providers and drug companies.  There is also greater transparency as drug companies start reporting what they give doctors. Transparency is a good thing.

It’s too bad that when it comes to politicians, it seems we are moving in the other direction — more money and less transparency.

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The Wall Street Journal (10/27, A1, Mathews, McGinty) reported a committee of doctors called the Relative Value Scale Update Committee (RUC) decides how much Medicare pays for various medical procedures. This committee wields considerable power over how Medicare dollars are spent.

It is good to have doctors deciding this?  Who would be better?  Government regulators?  In private insurance plans, the insurer and the doctor contract for what those prices should be.

We now have a health care system that largely removes from patients the direct responsibility of paying for care.  So if patients aren’t going to decide how much they will pay, it’s left to someone else — either the insurer or the government.  It may seem that leaving this in the hands of doctors may not be a great idea, but the RUC can’t pay doctors whatever it wants. It just sets the relative amount that one procedure gets paid vs. another.  It’s a zero-sum game, so that if one procedure is paid more, another is paid less.

So while the RUC is controlled by physicians, those physicians don’t change Medicare’s overall costs.

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What do doctors think?

Writing anything about physicians’ perspectives is difficult. Physicians’ perspectives vary incredibly across pretty much any dimension one would look at.  That makes the American Medical Association’s job pretty difficult.  As the organization that represents doctors, The AMA represents people across a broad spectrum of opinions.  The AMA weighs in on issues that can be very controversial, including measuring doctor quality and health care system reform.

Today on Getting Better Health Care, I interview AMA president Dr. Cecil Wilson.  He explains what the AMA is, how it works, and why it chose to be a productive participant in developing health care reform legislation.

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An August 2010 article in Physicians Practice magazine questions whether board certification of doctors is overrated. The article points out that board certification provides a guarantee of a certain level of knowledge and that recent board certified doctors are required to maintain that certification with periodic examination over time. The article also pointed out that studies have not found definitive evidence that seeing a board certified physician results in better outcomes than seeing a doctor who isn’t board certified.

No study will probably ever show a big difference between board certified and non-board certified physicians, perhaps in part because the great majority of U.S. physicians are board certified. We can almost take for granted that U.S. physicians practice within the scope of their training because of the existing certification system.

The American Board of Medical Specialties (ABMS) is a supervising board that oversees the board certification of 24 medical specialty boards. You can find out if a doctor is board certified at their Web site www.abms.org. You can learn more about board certification by listening to the conversation I had with Dr. Kevin Weiss, President of the ABMS , on Web Talk Radio.

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