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.

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. 

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?

..Maurice.

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.


PT 


NOTICE: AS OF TODAY FEBRUARY 20, 2012 "PATIENT MODESTY: VOLUME 47" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 48

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

Do Oaths and Rules Make a "Good" Doctor?

Do oaths and rules make an ethical and caring physician?  

In the realistic and present day world of medical practice, the way medicine is practiced both in terms of emphasis or de-emphasis of oaths, medical school teachings and established legal and professional requirements are going to be different between one physician and another. There are going to be shortcuts and at times excesses depending on the situation and even the mood of the physician. Doctors are going to take chances or they will strictly follow what they believe are standard operating procedures ("standards of practice"). Yes, the Oaths are there, the laws and professional requirements and all the tools for professional behavior as provided by the medical schools are there but in the end, each doctor in their own professional environment will obey them as they see fit at the time. And it is up to their patients and their colleagues to finally grade the doctor. 

Do oaths and rules make an ethical and caring physician?  My conclusion is "probably not". I think it takes more than that. And, if you agree, what "more" is necessary? Let's read your thoughts on the subject. .Maurice.

Should Doctors be Allowed to Strike?

Currently, there is a strike by 10,000 physicians at public hospitals in a state of India in an attempt to get better salaries and work opportunities similar to those in other federal hospitals in India. The government has suspended 40 doctors, and 390 others have been arrested for failing to perform their duties.

Over the years there have been physician strikes elsewhere in the world and in the United States for various reasons including the high cost of malpractice insurance.  A 2004 article in the American Journal of Bioethics by Autumn Fiester argues the ethics against walkouts by physicians, in this case the issue has been the increasing malpractice insurance cost rates not keeping pace with physician reimbursements.

   

My question to the visitors to my blog is whether physicians have a right to strike and if so for what reasons and  if they do, is such individual physician termination of services, without any replacement provided ethical? ..Maurice.

Patient Modesty: Volume 46

Continuing on with the discussion regarding issues of physical modesty in the context of medical care, there continues to be debate throughout these Volumes as to who is responsible for the contested inequalities in attention to these issues and what is necessary for the resolution of these issues.  Is there a conflict between the male and female gender, working apart, in attaining their own individual modesty goals or should both genders look to each other's physical modesty needs and desires and stand and work together to change the medical care system to meet all their goals? I suspect the latter is the wisest.  Perhaps the best suggestion for both genders to become active to the same cause and to get together on a website to develop tools for advocacy.  I would suggest checking in at Suzy's site where the goal is to do just that.  Here is her description of the Mission Statement and Goals:

MISSION STATEMENT:
We believe that each patient is an individual and as such has specific preferences and needs including what accommodations they require to maximize comfort when their modesty must be compromised in the medical experience. Our mission it to act as a liaison between patients and providers in establishing, understanding, and executing the policies and procedures essential to that end. When appropriate we will act as advocates for patients to achieve that goal through interaction, education, and referrals to both patients and providers.

GOALS: Our goal is to help patients achieve dignified and respectful healthcare through education and information. Everyone has different needs and expectations of their healthcare providers, and we provide choices and options in obtaining those needs. We understand that modesty, privacy, and respect are primary needs when facing procedures and we promote educating providers in the sensitivity of those needs.

ADDENDUM (12-23-2011)

 On 12-23-2011, Belinda wrote the following comment : Going back the the "Naked" article, it would seem that now is the time to write protocols for exams with dignity at the forefront with equal accessibility as needed for any kind of exam making draping practices uniform. It would give patients and idea of what to expect and do as much to relieve the awkwardness of such an exam. Any thoughts on this?

I responded with the following:

Belinda, an EXCELLENT suggestion! In fact, to make the suggestion even more productive.. how about the visitors here (even you PT) together create a final consensus list, a series of suggested protocols for attending to all the patient modesty issues experienced in medical care. The development of the list can written to this blog or Dr. Sherman/Doug Capra's or on Suzy's blog.

But not just writing this protocol list to our blogs.. the final consensus list should be sent to Dr. Atui Gawande who wrote the article "Naked" in the New England Journal of Medicine and which was the basis for our entire series of Volumes on patient modesty. As some of you may know, Dr.Gawande is now a very well respected individual for his analysis and writings about a host of important medical issues that need fixing or change. By this project on our part, this may be the most direct way, through Dr.Gawande, to get something moving rather than repeated moaning and yearning on our blogs. How is that for an idea? Again, thanks Belinda for a suggestion to get us all "off our butts" (so to speak). 



..Maurice.
Graphic: "Man and Woman Apart and Together"-Classic icons modified by me with ArtRage.

NOTICE: AS OF TODAY JANUARY 11, 2012 "PATIENT MODESTY: VOLUME 46" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 47

Should Patients Have Online Access to Their Medical Records?

Should all patients be given online access to their medical records? The British healthcare system is currently considering such a possibility. With electronic medical records progressively becoming the norm throughout the medical world, this access would be feasible but would it be wise? Certainly, there would be advantages to the patient who would readily see the written result of the office visit and could then, if necessary, confront the physician with corrections, additions and questions and in a timely fashion. But what are the negatives to such an idea beyond potential loss of patient privacy due to inappropriate or illegal computer access? For example, would this mean that the medical record would have to be written in words understandable by any patient rather than in more concise and professionally understandable terminology and thus perhaps degrade professional communication? Would such access more easily give rise to patients starting malpractice actions due to misunderstandings of what was written to the record? Could patient's be pressured by others (insurance companies or employers as examples) into providing access to the electronic records since they would be more readily available? What do you think? ..Maurice.

Do We Own Our Own Germs?: Ethics and Law in Research

From the current New York Times Sunday Review: IMAGINE a scientist gently swabs your left nostril with a Q-tip and finds that your nose contains hundreds of species of bacteria. That in itself is no surprise; each of us is home to some 100 trillion microbes. But then she makes an interesting discovery: in your nose is a previously unknown species that produces a powerful new antibiotic . Her university licenses it to a pharmaceutical company; it hits the market and earns hundreds of millions of dollars. Do you deserve a cut of the profits?
In on ongoing legal challenge to the patent law which allows isolated human genes to be patented and which was previously overturned, the Court of Appeals for the Federal Circuit of the United States returned a ruling earlier this year that these genes were not simply a product of nature, which would not be eligible for a patent, but indeed could be patented. So..who has the legal rights to that rare and valuable germ growing in your nose or that gene which was part of your body but the one that was recovered and used for, as an example, a genetic test for cancer? And beyond the law.. what are the ethics? What is the good vs bad, what is the right vs the wrong?

..Maurice.