Of course, it's of strong advantage to use computers as reference
tools, however, exactly the same tools are frequently used 'against'
patients because of well-known dependencies within countries related
health systems etc. Also, the doctor's final word again is a matter of
his view, education and experience.
A small example may show, first, doctors' views, then more general
relations determing the doctor's final word.
In a recent (2000) survey, 214 general practitioners were asked to
decide for the most relevant lipid parameter/-s on which they woud
rely the prescription of a strong lipid-lowering drug in a male
patient, 50 y, one heart attack, smoker. In summary: 8% replied total
cholestrol, 30% LDL, 2% HDL, 3% triglicerid/ HDL ratio, none
triglycerides, 29% LDL/ HDL ratio, and 27% more than 1 parameter or
ratio (rounded values).
Besides about 70% (!) of the replies not agreeing to current medical
knowledge or consens, the differences in replies also indicate the
differences in doctors' views when selecting prognostic relevant
factors.
Further and even more important, institutions and organisations (i.e.
health insurance, medic aid/ care) relevant for the doctors' budgets
again calculate different and determine the doctor's final word, too:
15 patients taking strong lipid-lowering drugs for one year (which is
necessary to show the desired effect) approximately cost the same
amount of money as hundred thousand of patients which would benefit
from a low-dose aspirin in-take (after a 6 weeks initialisation
period) -- and which both result in preventing 1 (one) death.
Specially this last aspect is relevant within our health systems, also
with the frequent consequence that patients will not receive optimal
but low-budget treatments, even in hospitals (mostly under the 'cover'
of 'quality improvement'), no treatment at all (i.e. expensive
treatments in old patients) or serious delays in treatments -- if
complications are to be expected which would 'lower' a hospital's or
doctor's 'level of quality'.
Unfortunately, treatment delays are mainly based on exactly those
computers that are set up for suggesting, testing and comparing
differential diagnoses. In practice, the reliable and/ or early
detection of possible complications threatening to lower hospitals' or
doctors' quality, frequently, prevents treatment or an optimal
treatment, which is the other side of this medal -- this time from
patient's view.
-----------
On Mon, 08 Jan 2001 10:18:59 -0500, Rich Ulrich <[EMAIL PROTECTED]>
wrote:
> - This morning, I asked a doctor, "Whatever happened to computer
>diagnosing? It used to look so promising?" Then he spent a few
>minutes telling me about it - "It's being used everywhere."
>
>Computers give reports on what seems interesting in EEGs, or in
>X-rays. That's one level of help. At the higher level, I remembered
>that there had been questions - 15 years ago - of using "computer
>diagnoses" because of legal liability. And, I thought, keeping
>up-to-date had to be problematic.
>
>It looks like that has been finessed by keeping the computer in the
>background as another reference tool. My friend says that at
>Mass.-General, every department has computers that are set up for
>suggesting, testing and comparing differential diagnoses. However,
>the doctor always has the final word. I had not been aware of all
>that.
>
>--
>Rich Ulrich, [EMAIL PROTECTED]
>http://www.pitt.edu/~wpilib/index.html
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