Comments on: Doctor’s Diagnosis, Version 2.0

By: K

Fri, 25 Jan 2008 05:11:36 +0000

This wonderfully written article highlights one of the major problems plaguing the U.S. health care system today, which is the lack of Information Technology (IT) being utilized. When the landmark national reports produced by the Institute of Medicine came out, they exposed the inadequacies that plagued the U.S. health care system and the need for major reform. Consider this: 44,000 to 98,000 preventable deaths occur each year due to medical errors. This should not come as a surprise given the lack of IT in health care. If IT were used more in health care, medical errors would be reduced (e.g., giving the wrong drug, or the wrong dose, or the right drug but to the wrong patient), and diagnostic accuracy would certainly be improved, along with better treatment plans (e.g., through decision support systems at the point of care).

So why has the health care industry been so slow to adopt IT? Well, probably many reasons, cost being among them, but I definitely agree with the author when she asserts that, “doctors’ psychological barriers may be even harder to overcome than these technical issues.” As the younger, more tech savvy physicians come of age we will definitely see greater adoption of IT, and on all levels (from decision support systems at the point of care, to more heavily “wired” hospitals and physician offices, to increased internet tools for patients). For the time being, as the author notes, it is extremely important for patients to be more involved in their care. Hopefully this will provide a push, or tipping point, to spread the adoption of IT in health care.

By: Digitaldoc, MD

Digitaldoc, MD — Tue, 08 Jan 2008 22:12:54 +0000

As a physician, I feel these expert systems can be improved on two areas which should then prevail over other reasons why docs don’t use them much:

1. They are mostly 1-way counselors – if these systems can be customizable allowing the doc can teach them, customize them and propogate them to other users like a 2.0 ‘avatar’, that will be great and allow docs to be ’stars’. For example – my own customized and “tutored” expert system application could be ’subscribed” or “rented” by other doctors to drive their own expert systems in part (like for specific disorders) or in entirety

2. The systems need to have a case-based-reasoning functionality allowing them to learn themselves to fine-tune their diagnostic skills depending on the pattern of patients in a given geographic area, rather than being static knowledge bases at the mercy of vendor updates…

By: Victor

Victor — Sat, 05 Jan 2008 21:45:41 +0000

This very well-written article makes clear that despite potentially life-saving utility, these programs are infrequently used, and answers that apparent paradox with a number of valid explanations. As a physician, I would add that the time pressures on physicians are so great and the cumbersomeness of the programs is such that it would be impossible to expect every physician to use this aid on every patient.

Perhaps the most effective way to use this technology would be to have a non-physician professional with a laptop review every hospital chart and use the algorithms to be sure each patient is being treated properly. Now we’ll have to figure out how to get reimbursement for this task from the insurance companies.

By: Ralph

Ralph — Sat, 05 Jan 2008 18:15:30 +0000

As a patient (and potential patient in the future), I was glad to learn about these diagnostic tools and how reliable at least some of them are. This article makes me feel more empowered to speak up, as do the guidelines in Mark Graber’s informative Comment.

By: Mark L Graber

Mark L Graber — Fri, 04 Jan 2008 15:52:14 +0000

This article does a real service by bringing to greater attention the problem of diagnostic errors, and the potential role of decision support products in helping to improve the reliability of medical decision making.

Although informatics solutions are appealing, the article correctly emphasizes that patients can play a substantial role in helping to reduce these errors by being proactive – ask questions, ask about other possibilities as the author suggests, and most importantly learn the expected course that the physician expects, and how to get back to him\her if the real course is different.

Readers of this article would also be interested to know that the issue of diagnostic error will, for the first time, be discussed at a national forum this Spring. “Diagnostic Error in Medicine” is a 2 day conference co-sponsored by the Agency for Healthcare Research and Quality (AHRQ) and the American Medical Informatics Association (AMIA). Conference details can be found at

http://www.amia.org/meetings/s08/dem.asp