Do Decision Tools Make Doctors Look Like Idiots?
This is David Williams writing at The Health Care Blog:
A HealthLeaders article by Gienna Shaw notes that some physicians are reluctant to use computerized decision support (CDS) tools because they fear losing the respect of patients and colleagues. There’s some evidence to support this concern:
In one [study], even tech-savvy undergraduate and graduate computer science students preferred physicians who rely on intuition instead of computer aids.
“Patients object when they ask their doctor a question and then she or he immediately types in the question into their laptop and then reads back the answer. It gives patients the feeling that they just paid a $25 copay to have someone Google something for them,” [study author James] Wolf says….
I prefer physicians who uses sophisticated decision support tools such as SimulConsult, which allows physicians to extend their expert knowledge to make differential diagnoses of rare conditions that even excellent, experienced specialists may see rarely in the course of a career. Doctors are trained to see horses, but there are a lot of zebras out there that are being missed as a result.
I’ve also heard that doctors shy away from decision-support tools. I find it hard to fathom that a profession would not use every tool at its disposal. For instance, the website FreeMD.com allows patients to input symptoms for an evaluation of possible ailments. Its database is the same one used by nurse call lines at the VA Health Administration. I inputted by late father’s symptoms and in seconds it promptly produced the correct diagnosis (aortic aneurysm), whereas his doctor at the 9-bed county hospital could only guess based on a low-quality X-ray.
I have never had a Dr. use SimulConsult during a visit, but would not be opposed to it. I want the most accurate diagnosis available. If using support tools makes that possible, I’m all for it.
It’s called “cookbook medicine.”
Doctors are right to be concerned about losing the respect of patients. Numerous studies show that patients are irrational. One study showed that patients prefer doctors to be able to spew out information even if they have no idea what they are talking about over looking up the information in medical textbook. I’m serious, research actually shows this.
In some ways cookbook medicine is idiot medicine.
@ Neil W.
Patients’ perception probably has to do with how well the doctor integrates the decision-support tools into his or her practice. For example, if I hire a lawyer at $250 per hour, I have the expectation that I’m paying by the hour for knowledge they should already have (that’s why they are worth $250 per hour). If my lawyer began pulling law books off the shelf and thumbing through them like they didn’t have a clue, I might wonder why I’m paying $250 an hour for them to learn what I thought they should already know.
On the other hand, if my attorney makes it appear like they are referencing a body of knowledge they are very familiar with, I would assume they know what they are doing and my money is well spent.
It’s all in how it’s presented.
The Shaw article is a round-up of opinions. Other people were suggesting that the docs thought it made them look dumb. In the “study,” waiting room patients were asked to rate scenarios. There was no information quoted on what the docs thought.
Furthermore, a lot of the opinions come from people who work in information systems. No self-interest there. Plus there’s the silly claim that using evidence-based medicine will require decision support, as if evidence-based medicine is anything more, right now, that a bunch of statistical averages for sample groups with unknown variation relative to the individual patient sitting in front of the physician.
In fact, Shaw delivers her opinion of the opinions she describes by saying “I’m not buying it.”
Which should have been the headline.
Good topic. I think Neil Versel offered some interesting perspectives on the topic of CDS and public perception of doctors who use it in this article: http://www.emrandhipaa.com/neil/2011/04/21/more-unrealistic-expectations-from-the-public-this-time-involving-cds/ There’s definitely a balance to be had between utilizing the tools and assisting the patient in the best way possible.
I agree with Devon. As long as we don’t see the man behind curtain, we are perfectly content.
Though I think physicians should take this into consideration. My mom saw our family physicians multiple times before he finally told her he couldn’t figure out what she had. He sent her to another doctor, who told her that she probably had cancer in the first visit. If doctors can share this information among each other, why not, it will save the patients money and time, along with the physicians time.