Tuesday, January 31, 2012

Cyberchondria: "Doc, I Know My Diagnosis, Tell Me if I am Right"

With the widespread access to the Internet and all the "medical information" sites throughout, it is not surprising that "cyberchondria" (patient worries about diagnoses that they obtained by researching the Internet) is becoming a common experience for physicians to encounter.  Read the article in Amednews.com (American Medical Association News) about cyberchondria and return and let's talk about it.  What are the "goods" and what are the  "bads" aspects of this Internet educational opportunity?  ..Maurice.

Thursday, January 19, 2012

A Doctor's Decision: Whether or Not to "Call the Cops"

A most interesting scenario was posted on Medpedia by Scott M. Dyck which I am, in part, reproducing here but you might want to go there to review the responses there but also feel free to make your comments here. If you were the doctor in this case, what would you do? ..Maurice.

You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. 

Saturday, January 14, 2012

Doctor vs Computer: Can a Computer Make a Better Diagnosis?

I found this visitor question on a discussion forum:" i was debating this with some doctors who say that it would be impossible to program a computer to make diagnoses as well as they can. i find this pretty ridiculous. whatever thought process/string of questions they would use to analyze the situation are the same that the computer would be programmed to use. the compute:r would then analyze all available information, ask questions, analyze the answers and assign probabilities. in fact, it seems like this would be way simpler than some of the things computers have already been programmed for. what do u think?"

So what do I think? 
My opinion, as a doctor, is that  what is input into a computer for calculation is the most important  part of the process of making a diagnosis and deciding on a treatment program to benefit the patient.   No amount of computer power or access to data storage will substitute for the physician's input of the history and the physical findings of the patient.  A computer posing questions to a patient and the patient responding will never substitute for a direct doctor-patient communication.  There are many subtleties, nuances  of a history which can never be accessed by a computer, such as body language and verbal expressions  and there is no way for a computer to perform a complete and worthy physical examination.  A robot used in surgery still requires a doctor behind it and no robot will attain the skills to inspect, auscultate, palpate and percuss and then interpret  the findings.  To me, how complete and understood is the input of data both from a patient telling a history and the doctor performing a physical is the basis for the diagnosis.   Poor input will always lead to poor output.  And, finally, it will always take a doctor to analyze the results of the computer to confirm its diagnosis.  I would agree that the doctor with knowledge and with experience and then working together with the computer can be most productive of  the correct diagnosis.

So.. what do you think?


Wednesday, January 11, 2012

Patient Modesty: Volume 47

We continue here the discussion regarding how the concerns about healthcare provider gender selection by patients and ways for the patient to be more comfortable with those who attend them can be brought to the attention of all those who provide service and maintain the status quo in the healthcare system.  ..Maurice.

ADDENDUM (1-16-2012)  On this date, PT, a long-time writer to this thread on Patient Modesty, wrote the following comment which includes a potentially valuable suggestion for a method for those who want to change the current medical system regarding patient modesty and caregiver gender selection.  This is what he wrote:
Alan said

" Rosa parks was a single woman who started
a movement with a single act of resistance,Malcolm X
took another path and my style is more like Rosa parks
than Malcolm."

My style is more like Genghis Khan until I
realized that the pen is mightier than the sword. My idea
to solve this issue is a 40 step process, meaning I have
put together 40 different avenues of approach over a
period of about 10 months.

Here is the first avenue, visit www.change.org
to start a petition. Now I suggest you start perhaps at a
hospital or clinic that you in the past had concerns with.
Others around the world will join the petition
and to be effective use multiple facilities in each city. Keep
in mind this is a medium to bring our concerns forward. The
first of many mediums we will use as I suggested in volume
46 of Dr. B's blog.



Graphic: From Google image resource modified by me with Picasa3.