Category: Technology

Saying no to CT

published date
November 2nd, 2006 by

Saying no to CT

Advanced CT scanners have revolutionized trauma care and provided physicians with lots of information to aid diagnosis and track treatment progress. Utilization has gone through the roof, which is good news for radiologists and hospitals but bad news for payers. There has been no significant progress in holding the line on imaging costs, the way there has been on drugs, for example.

But there is growing concern over the high dosage of radiation that some patients receive from CT scans, according to the Wall Street Journal. A chest CT exposes the patient to 8-10 millisieverts of ionizing radiation. That’Â’s 100 to 1000 times as much as a chest x-ray, and about half of the exposure received by the average atomic bomb survivor in Hiroshima or Nagasaki. Some patients get dozens or even hundreds of scans. No doubt not all those scans are necessary.

I’ve always been leery about medical radiation exposure. My mother was conservative about letting us have our teeth x-rayed, and she was probably right. If payers want to rein in CT costs, they’d be wise to tap patient safety concerns. However, if they aren’t careful they will just drive up the use of MRI, which costs even more.

Making peace between perfume wearers and asthmatics?

published date
October 13th, 2006 by

Making peace between perfume wearers and asthmatics?

From the BBC (Creating a stink in the name of science), about the work of a professor in Tokyo:

One of the most ambitious devices his team has built is a sophisticated “odour recorder” which can sniff an object and then reproduce its smell using a host of chemicals.

If you present the recorder with a shiny red apple, the electronic nose will take a cursory sniff, analyse the odour and then draw up a recipe of chemicals needed to recreate it.

When you want to replay the scent, the device mixes the ingredients and pumps the smell of apples back at you.

The system is already attracting interest from the scent industry. As the professor excitedly showed off his gadgets, two executives from a large Japanese fragrance firm eagerly watched.

Many but not all perfumes trigger asthma. Since each perfume is made up of tens of ingredients it is likely that only a few of the ingredients are asthma triggers. If a company stocks its odor reproducer only with asthma-safe chemicals it can produce asthma-safe perfumes. Once it becomes clear that some perfumes are asthma safe, there will be a strong incentive for other companies to follow suit.

Thanks to Mickey.

How decision support tools could address the malpractice “crisis”

published date
October 3rd, 2006 by

How decision support tools could address the malpractice “crisis”

I’m a big advocate of decision support tools like SimulConsult and Safemed, which can help doctors make better diagnoses and treatment decisions. A new analysis of closed malpractice cases provides powerful ammunition for more widespread use of such tools.

From the Boston Globe (Basic errors hurt patients):

Basic errors made by doctors, including tests ordered too late or not at all and failure to create follow-up plans, played a role in nearly 60 percent of cases in which patients were allegedly hurt by missed or delayed diagnoses, a study [in the Annals of Internal Medicine] found.
[M]ost claims involved several factors;… major ones included mistakes by doctors: failure to order appropriate diagnostic tests (100 cases); failure to create a proper follow-up plan (81); failure to obtain an adequate history or perform an adequate physical examination (76); and incorrect interpretation of tests (67).

The study’s lead author, Dr. Tejal K. Gandhi, director of patient safety at Brigham and Women’s Hospital , said the research shows that doctors could use more help in making decisions…

“I don’t want to say that it’s not the physician’s responsibility,” Gandhi said. “We think there could be tools to help physicians make these decisions better.”

When errors in diagnosis and treatment occur, people often conclude that doctors should know more about the disease in question. That’s part of the solution, but as Dr. Gandhi points out there also needs to be more focus on tools to help the doctor, not just piling more information on the doctor and encouraging the doctor to order more tests.