Category: Technology

Helping doctors help themselves

published date
March 19th, 2007 by

Dr. Jerome Groopman, chief of experimental medicine at Beth Israel Deaconess in Boston, has a good article today in the Globe (The mistakes doctors make. Errors in thinking too often lead to wrong diagnoses.)

According to Groopman:

Misdiagnosis occurs in 15 to 20 percent of all cases…and… in half of these, serious harm occurs.

Why do we as physicians miss the correct diagnosis? It turns out that the mistakes are rarely due to technical factors, like the laboratory mixing up the blood specimen of one patient and reporting another’s result. Nor is misdiagnosis usually due to a doctor’s lack of knowledge about what later is found to be the underlying disease.

Rather, most errors in diagnosis arise because of mistakes in thinking.

The 15 to 20 percent figure is unacceptable, especially when we think of the financial costs and the toll in patient suffering. Groopman points out that few clinicians understand their own thought process –which isn’t so surprising. A top-notch physician I know somewhat sheepishly describes his style of thinking about patients as “mulling.”

I’m passionate about shortening the diagnostic odysseys that patients often endure before finding the right diagnosis and am an adviser to SimulConsult, which makes a decision support software program that also does a bit of “mulling.” But because it is a computer program no one is sheepish about vagueness of process.  The program can consider far more diseases than a person can. It can also suggest additional findings that would be useful to check. It does away with the problems of “premature closure” and “confirmation bias” Groopman cites.  Medical educators are attracted to using the software to make explicit the cognitive processes that doctors should be learning.

We can interrupt the cascade of cognitive mistakes and return to an open-minded and deliberate consideration of symptoms, physical exams , and laboratory tests — and in this way close an important gap in care.
Cognitive insight alone is not a full solution.  It is hard to keep that many possibilities in mind without using software, and contrary to the article there are indeed many cases in which the problem is “lack of knowledge about what later is found to be the underlying disease.”

A diagnostic odyssey

published date
February 28th, 2007 by

There’s a good Cases column in today’s New York Times (A Mystery Ailment, but not for the Right Doctor) about a patient with a mysteriously sore foot. He’d done his research on the web and sought out a tropical medicine expert (the author of the Times article) to test his theory that the problem was caused by a mosquito bite he got in India. To make a long story short, what he really needed was a bone and joint expert. Partly by luck he ended up seeing one and having his condition diagnosed properly.

If you already know your diagnosis –even if it’s for something obscure– it’s not hard to find good information about it on the web. But if you have only a collection of symptoms to go by, you’re in much tougher shape (even if you try your hand at Google diagnosing). It’s hard to even know what symptoms or other findings are relevant and what kind of physician to go to. You could go to one that causes more harm than good or ends up prescribing a medication that masks symptoms another doctor would need to make an accurate diagnosis, as happened in this case.

There is an answer to this problem: consumer-focused decision support tools that help patients figure out what kind of physician to see and what information to present. I predict you’ll be hearing more about this approach within the next year.

Note: the Times site was down so I’ve linked to the same article in another newspaper. 

My kind of doc

published date
February 23rd, 2007 by

Last day of vacation and no real time to blog, but two people sent me a link to today’s WSJ article: Faltering Family M.D.s Get Technology Lifeline; Doctors Think Small To Revive Solo Role For Primary Care.

They rightly concluded that I would applaud the efforts by some primary care physicians to offer a high-service model to a regular sized panel of patients by relying on technology and intelligent operations. It’s a much better solution than the concierge model.

[I]n early 2001, Dr. Moore took a risky step. He borrowed about $15,000 to start a solo medical practice in a tiny space with no nurse, receptionist or waiting room. He bought computer software to help him track patients’ appointments, illnesses and medications, and to process insurance claims.

Patients at his “micropractice” can call or email to get appointments the same day. Visits last 30 minutes. Dr. Moore can be reached day or night on his cellphone. To refill a prescription, he walks “zero feet,” he says, and taps a few keys on his laptop. “I was able to build a Norman Rockwell practice with a 21st-century information-technology backbone,” he says.

More later…

Just imagine what HDTV could bring

published date
February 2nd, 2007 by

It’s a good thing doctors in Ireland have time to watch television:

An Irish doctor, however, has [performed a diagnosis] while watching television by spotting that a government minister had a tumor in his cheek.

The… surgeon…was at home with his doctor wife before Christmas. They were following a current affairs program…in which… the overseas aid minister… was being interviewed.

“If you look very carefully,” the surgeon reportedly told his wife, “his face moves when he talks but the lump doesn’t.”

The next day he called the minister’s office and left a message. [The minister]… phoned back and the surgeon told him about his fears, advising him to see a head and neck specialist at a Dublin hospital immediately.

Doctors… carried out tests and quickly found a tumor on his salivary glands. It was removed during an operation last month…

[The minister] told the Irish Independent newspaper: “I’m a very lucky man. The consultant wouldn’t have seen the left side of my face but for the fact that I was sitting at the left of the group in the television studio.

Thanks to Mickey for spotting this one.

Pfizer and iCardiac announce cardiac safety alliance

published date
January 30th, 2007 by

I recently joined the board of iCardiac Technologies, which is commercializing ECG analysis technology from the University of Rochester’s renowned Heart Research Follow-Up Program (HRFUP). I’m excited to pass along the news that Pfizer and iCardiac have agreed to an alliance. According to the press release:

The aim of the research alliance is the further development of iCardiac’s COMPAS platform and advanced ECG markers for use in the safety testing of in-development and on-market drugs, and includes a cross-licensing arrangement by which iCardiac will receive rights to ECG analysis technologies developed within Pfizer.

Under the terms of the agreement, iCardiac and Pfizer will collaborate on a research program comprised of a series of studies, including retrospective and prospective ECG data analyses. iCardiac will receive an equity investment and technology license payment, plus research and development funding over the term of the alliance. iCardiac will retain commercial rights to the validated technology platform and new biomarkers for future application in cardiac safety clinical trials and technologies.

…As part of the Critical Path Initiative, the FDA has stated that there is a significant opportunity to further improve the cardiac safety testing process and identify better markers of cardiac risk. The long-term goal of the alliance is to improve the precision, increase the speed and reduce the costs of cardiac safety clinical trials. Â

Pfizer spokeswoman Kate Robbins said:

“Cardiac safety is one of the most challenging hurdles in developing new medicines. We support the development of new tools that may enhance our ability to predict the safety of potential new medicines in early stages of research and development.”

iCardiac’s tools are exciting in two ways: 1) They may knock out drugs with cardiac safety problems earlier in development –saving lives, money, and time. 2) For certain drugs that are wrongly flagged as potentially dangerous using cruder methods, they may allow development to proceed. That would help more good drugs make it to market.

Congratulations to CEO Mikael Totterman and the entire iCardiac Technologies team.