Right diagnosis, wrong prescription

Ivanhoe.com has a good OpEd from the director of “In Need of Diagnosis,” which highlights the need for improvements in diagnosis. However, the article veers in the wrong direction in its recommendation to establish a new specialty in medical diagnosis. Instead, the focus should be on empowering generalists, e.g., by putting clinical decision support software such as SimulConsult in their hands. I’m on the advisory board of that company, which is featured in Professor Clayton Christensen’s new book, The Innovator’s Prescription.

Excerpts from the OpEd:

It is understandable that some of the more rare disorders might not be recognized by the family physicians, internists, pediatricians and gerontologists, the only ‘generalists’ in the medical system. These illnesses are, after all, rare. It is not reasonable to expect any doctor to commit to memory the myriad of symptoms and symptom patterns associated with 7,000 rare disorders. On the other hand, it is not reasonable to expect a person’s health and quality of life to be dependent on human memory — not even on a physician’s memory.

Medical diagnostic software is a developing technology that could be helpful to physicians in sorting through patient symptoms and the disorders with which they might be associated. As of 2005, the latest year for which figures could be found, it was estimated that less than 2 percent of the physicians in the United States were using this technology.

A 2006 report said that despite the sophisticated diagnostic tools available, “Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time” and “…the rate (of incorrect diagnoses) has not really changed since the 1930’s…” The Journal of the American Medical Association looking at the history of diagnosis concluded “No improvement!”

For those with a rare disorder, it can take years, a lifetime, or death, to obtain an accurate diagnosis. Sufferers go from doctor to doctor hoping one will recognize a defining symptom. When the disorder continues to elude diagnosis, physicians, family and friends who had been supportive initially, may begin to question the validity of the person’s complaints. At that point, support is withdrawn and the afflicted individual finds themselves abandoned socially and emotionally as well as medically.

In a free market economy, it should be the consumer who ultimately determines the nature, quantity and quality of goods and services provided. We, the people, are the consumers of medical services. We need to make clear to the medical system the type of medical services that are desired and required.  Physicians as well as patients are disadvantaged under the present system. Physicians who have patients with complex disorders involving multiple body systems have no colleagues to whom they may refer these patients for diagnosis.

There is a great, unmet need in the medical system for a specialty in the field of medical diagnosis.

Software is a better solution and can be implemented faster than a new specialty in any case.

February 12, 2009

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