June 29th, 2008 by Dr. Val Jones in Opinion
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I realize how incredibly tempting it is to reduce medicine to a series of algorithms. Wouldn’t it be nice if we didn’t need to see a doctor to diagnose our ills? Wouldn’t it be great if our computer could tell us what’s wrong, and prescribe next steps for us? Wouldn’t it save money if we could triage peoples’ medical needs without human intervention?
Unfortunately, we’re not there yet. A friend of mine posted a link (on Twitter) to an online triage tool called “FreeMD.” The tool describes itself this way:
FreeMD® is an electronic doctor that conducts an interview, analyzes symptoms, and provides expert advice — for free.
So I decided to try it out. I imagined that I was a hypothetical patient – a woman in her mid thirties who had had abdominal surgery in the past and was now experiencing mild to moderate abdominal pain. My imaginary patient has abdominal adhesions from the surgery, which is causing her to have bowel pain – which could become an obstruction and surgical emergency.
I answered all the questions posed by the free MD and he responded that he had determined the most likely cause of my pain: tubal pregnancy or threatened abortion.
This response was offered even after I indicated that I was not pregnant. What would the average consumer think of seeing “threatened abortion” as a potential diagnosis for their abdominal pain? Would they know that this was the medical term for miscarriage or would their mind race to abortion clinics and ominous threats?
The problem with this tool is that it cannot take into account all the subtle co-morbidities and nuanced historical information necessary to return an accurate result. In fact, no online tool can replace a healthcare provider’s evaluation of a patient. Attempting to do so is like playing Russian Roulette with your health. Maybe you’ll get lucky and happen upon the correct diagnosis and treatment, but maybe you’ll be horribly misled and suffer irreperable harm.
Of course, companies like freeMD contain disclaimers about the service not being a substitute for a physician’s oversight. But the reality is that people are using the service to make decisions about when and if to see a professional for further evaluation. As a concerned physician, I worry about patients being misled about their health. I want patients to be empowered and to learn all they can about their disease or condition – but self-diagnosis, even with the aid of an algorithm, is fraught with danger.
My bottom line: computers will replace physicians when robots replace spouses. Similar satisfaction rates will come from either replacement option. People know instinctively that a good doctor is critical in managing their health – why else would there be so many physician rating tools, including the one here at Revolution Health? Why would Castle Connolly bother to publish their yearly “America’s Top Doctors” reports? This is not about paternalism – it’s an acknowledgement of the incredible complexity of human beings. And in this case my friends, it takes one (doctor) to know one (patient).This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 28th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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I had every intention of publishing my follow up Disney post today… but I’m afraid it’s not quite ready for prime time. So queue the musical interlude and enjoy some weird stuff from around the medical blogosphere…
Dr. Deb highlights a new fashion trend: high heel baby shoes. Join the discussion at her blog – do the shoes represent an inappropriate sexualization of infants, or is it just good fun that’s lost on the babies? You decide.
Medgadget presents the prosthetic solution to two-legged dogdom. This little puppy is getting around nicely thanks to a custom front end with wheels. The Ostrovsky brothers dub this “unbearably cute.”
Dr. Dino is surrounded by blooming cacti. Who knew that such flora existed in the northeast?
Dr. Joe, the part-time anesthesiologist, has found two amusing websites – the first will turn your name into an Ikea-style furniture label, the second is an audio survey regarding what makes noises annoying. As in, “Hey, do you wanna hear the most annoying sound in the world?”
And if you got that last reference – then you’re telling me there’s a chance… A chance you liked these links.
And on a more serious note, I’m going to interview Dr. Nancy Nielsen, new President of the American Medical Association, on Medicare cuts this week. So stay tuned for more of my unique blend of news, humor, touching stories, and high level interviews.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 26th, 2008 by Dr. Val Jones in True Stories
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I spent the last few days in Orlando, Florida with my husband’s extended family. His nieces and nephews were looking forward to the vacation for months in advance, because they were really excited about going to Disney World. However, two of their parents have disabilities – my sister-in-law has stage IV breast cancer with metastases to her hip (making it impossible for her to walk), and my other sister-in-law is married to a man who is hearing impaired. Therefore, navigating theme parks can be a real challenge for the family.
As a rehabilitation medicine specialist, I’m always interested in learning about special accommodations for the disabled. So I contacted Bob Minnick, the Technical Director of Global Accessibility and Facility Safety at Walt Disney Parks and Resorts, to find out what Disney had to offer guests with disabilities.
Bob kindly agreed to meet me at his office on the Disney World grounds, and we had an animated 2 hour conversation about all the exciting programs that his team of engineers have designed. I was impressed with the depth and breadth of services they offer and thought I should let my readers know about them – because even if you or a loved one has a disability, you can still experience “the magic of Disney.”
But before I explain the specifics of the special programs at Disney, I wanted to pause to tell you a true story based on some information that Bob shared with me.
***
A young, non-verbal teen with autism (we’ll call him Johnny) was raised in rural America by two loving parents with scarce resources. They spent all their extra income on services for their son, hoping to give him the best chance at social integration possible. Johnny liked to watch cartoons, and was partial to Disney movies. He spent lots of time viewing them, replaying them many times over. His mom would often try to engage him in conversation about the cartoon characters, but sadly, he remained silent.
Years passed and the parents saved up their money to take Johnny on a trip to Disney World since they knew how much it would mean to him. He had been watching Finding Nemo a lot, and they wondered if somewhere inside his mind he could relate to the little fish with the weak fin. So when they were poring over the Disney theme park brochures and found a show at Epcot Center called “Turtle Talk” with Crush (the turtle character from Finding Nemo) they were determined to make sure that Johnny attended.
When they arrived at the auditorium one of the greeters realized that Johnny had special needs and asked if he’d like to sit in the front row. His mom’s heart skipped a beat – this was going to be a great day for Johnny.
As the lights dimmed and the crowd of kids hushed, a large, animated, moving model of Crush floated effortlessly towards the children in the front row. The blue lights and waving seaweed made the stage come alive with ocean wonder. Johnny fixed his eyes on Crush, transported to another sensory world.
As the sea turtle approached Johnny – almost nose to nose – it spoke to him. “Hello dude, how are you today?” Said the turtle.
And with a slow, deliberate voice, Johnny replied clearly, “Hello Crush. Nice to meet you.”
Johnny’s mom burst into tears and glanced at her husband as the two embraced their son – he had spoken his very first words right there in the auditorium in front of hundreds of people. And although no one else understood the significance of his response – to Johnny’s parents, it was the happiest day of their lives.
You might even say it was magical.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 25th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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My husband’s brother is a police supervisor in Rochester, New York. I guess that gives new meaning to “brother-in-law?” Sorry, bad joke. But on a more serious note, I recently had the chance to interview him about his work experience with the mentally ill.
What surprised me about our discussion is that his perspective on life, as a law enforcement officer, seemed to mirror that of the physicians I know. He touched on the rampant lack of personal responsibility in this country, and how HIPAA rules can lead to unintended consequences (like endangering neighborhood children). I’m grateful that men like my brother-in-law are willing to put up with the seedier side of life every day, so that others can enjoy a reasonably safe existence. See what you make of his point of view. Do you see parallels with medical practice?
Dr. Val: What sort of interaction do you have with mentally ill individuals? Are you trained to handle them differently?
Sergeant Zlotkus: People call us all the time to complain about individuals with certain mental disorders – either for bizarre behavior or for being threatening and disruptive. We have daily contact with local mentally disturbed individuals so we generally know which ones have the potential to be violent. We also have an EDPRT (Emotionally Disturbed Person Response Team) that is trained to deal with the mentally ill. The usual police response of just “going in and getting yes or no answers” doesn’t work well with a disturbed person who doesn’t know how to handle emotions. There are times where reaching out to grab someone’s wrist can cause them to go berserk and bang their heads on your police car.
More and more people with mental health issues [that cause violent behavior] are being released into the public and officers are getting hurt. People often think that the police are not dealing with the issue because they see the same people on the streets again and again. The fact of the matter is that we take them into detention but once they’ve been evaluated in the hospital, the mental health professionals choose to deal with them as outpatients and they’re right back out in the community again. We can’t put these people in jail, and knowing what to do with them can be a really tough judgment call.
Where do you draw the line? Just because you’re annoyed with someone’s actions – is that enough to lock them up? If a person paces back and forth in front of your drive way four hours a day, does that mean they have to be taken away by the police? What if that’s their only offense and the other 20 hours of the day they are fine?
How do we make this situation better?
Sgt. Zlotkus: What would really help is community education – it’d be great if we could let people know about certain individuals, and whether or not their unusual behaviors should be cause for alarm. For example, a young man with autism might be treated with understanding and tolerance when he expresses unusual behaviors, but a person with a history of mental disorders and violence should be viewed with caution. People should have a lower threshold for requesting police intervention in that case. However, because of HIPAA, we’re not permitted to let anyone know anything about others mental health or potential risks to their family.
Dr. Val: Does HIPAA affect police safety?
Sgt. Zlotkus: Absolutely. We are not allowed to save data related to individuals’ health information – so that when known drug users (who have Hepatitis C) are arrested they may try to spit on us or bite us to transfer their infection.
We’re told to use “universal precautions” with everyone – but it’s simply not practical to go into every situation with face masks and rubber gloves. It’d be really helpful if we could protect ourselves and others with the knowledge of what the risks really are.
Dr. Val: Is burnout a problem in the police force?
Sgt. Zlotkus: I’ve been a police officer for 18 years. Two of my close colleagues committed suicide during that time period. There is a sense of burnout or frustration that we all get after a while because we see the same people committing crimes over and over again. Since I’ve been working the same beat for so long, I’ve actually seen three generations of dysfunction in certain families. The drugs and violence are transferred from parents to children and it perpetuates itself. Also, people call 911 for the silliest problems and we need to respond. One woman called us because her 5 year old was having a tantrum. I felt like telling the woman to put her child in the corner and give him a time-out – what are the police supposed to do about it?
The overuse of the police force by a small minority of people who know how to work the system can be frustrating. Some people bump their lip and then have EMS, the fire department, and the police department show up and take them to the ER. When you see the abuse of the system over decades, it can really wear on you.
Dr. Val: What would improve your work life? More funding for more police?
Sgt. Zlotkus: That’s a tough question. On the one hand it would be great to have more police helping with all the work, but on the other, if we doubled the police force and were able to arrive at every request within 60 seconds, there would be a whole new batch of people ready to call us for their every whim. More police would just mean more abuse of the system.
Dr. Val: What’s the biggest problem facing police today?
Sgt. Zlotkus: Nobody wants to take responsibility for their own actions. They want to blame others, sue anyone they can, or just let the government take care of them. Most people just don’t know what it means to be a good citizen anymore.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 24th, 2008 by Dr. Val Jones in News
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I was reading about disease statistics today and came across some interesting information. See if you can guess the condition based on these factoids:
Time of injury:
Summer season (highest incidence in July)
Most common on the weekends (usually Saturday)
Most common at night
Average age at injury: 31.7 years old
Gender: 82% male
Number of new cases per year in the US: 10,000
So, have you guessed the condition?
Fireworks injuries perhaps? Binge drinking? Syphillis? Sasquatch attacks? Nope, guess again…
The answer is…
Spinal cord injury.
Spinal cord injuries are most often caused by motor vehicle accidents (44%), followed by violence (24%), falls (22%), sports (most are diving) 8%, and other issues 2%. The most common level of injury is in the neck, resulting in paralysis of all four limbs.
Why should we be worried about Saturday nights in July? Because that’s when people are at the highest risk for spinal cord injuries. School’s out, drinking and partying commence, and young men (more commonly than women) may drive while intoxicated and crash their cars. Please be careful this summer everyone, no one thinks they’ll be in an accident, until it’s too late.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
