By Evan Falchuk
If you study misdiagnosis you realize how often patients get the wrong diagnosis. But what do expert doctors think about how often it happens? And what do they think can be done to address it? We wanted to find out so we partnered with the National Coalition on Healthcare to conduct a landmark, nationwide survey. We surveyed 400 cancer specialists from our Best Doctors database – and the findings were provocative.
Do people and computers “think” alike?
Not yet.
The NY Times reports on how people and computers make a diagnosis. It turns out there’s a doctor named Dr. Gurpreet Dhaliwal, who does a kind of medical high-wire act. He comes up with accurate diagnoses on challenging cases – in real time in front of an audience. Now, not every doctor can do what Dr. Dhaliwal does – but most can do something like it.
So, what is it that doctors are doing when coming up with a diagnosis? And can a computer do it, too?
Many doctors have an “encyclopedic” knowledge of areas of medicine. But knowledge isn’t the same thing as insight – the ability to put together diverse pieces of information in a way that reveals the connections between them. A computer can be programmed with all of the medical information ever discovered, but without insight, it’s no more valuable than a book on a shelf.
Even with advances in computer “thinking,” this is where the trouble lies. Studies find that for as common as misdiagnosis may be (it’s estimated to happen between 15%-28% of the time), a lack of knowledge is rarely the cause of these misdiagnoses. Instead, the problem is usually a failure to put the pieces of the puzzle together in the right way. It’s a failure of what scientists call “synthesis,” and what the rest of us might call “insight.”
So computerized tools do have a role to play, if what they can do is trigger the doctor’s natural ability to apply insight to a problem. Tools that help doctors question their assumptions about a case would, based on the research, be highly valuable. But too much of the current focus of healthcare information technology is on prodding doctors to make sure they keep a detailed record of the fact that they, for example, counseled a patient to stop smoking. Instead, we should use the remarkable technology already available to do something far more valuable – help doctors do exactly what we really want them to do.
Think.
By Evan Falchuk
Watson, IBM’s powerful artificial intelligence system gained huge notoriety on Jeopardy! by defeating the show’s best-ever human player, is an important achievement. It’s leading to the next question – what else can it do? There’s a lot of talk that it could solve our healthcare quality problems. Brandon Keim at WIRED magazine has written a very interesting piece on whether this is really something that is possible.
As a member of the Watson team put it:
A machine like that, with massively parallel processing, is like 500,000 of me sitting at Google and Pubmed, trying to find the right information.
It sounds good – but is a lack of knowledge really the problem in healthcare? Or is it a lack of time for doctors to build relationships with their patients?
Read the whole thing – it’s a provocative article.
By Evan Falchuk
I’ve just finished up speaking at the Conference Board’s Employee Health Care Conference in New York. I presented with Sandra Morris of Best Doctors client P&G, and we talked about how companies are keeping health care costs under control. They’re doing it in a surprising way.
By Evan Falchuk
The March issue of MORE magazine dedicates its “Medical Mystery” column to the problem of misdiagnosis. Here’s a taste:
Americans believe that diagnosis is the cornerstone of medical care: You go to a doctor, who labels your problem and prescribes a treatment that makes you well. But what if the process gets stuck at the labeling stage? “We have a fantasy that as soon as we describe our symptoms, the doctor will know what is wrong with us. But the reality can be much more complicated,” says Evan Falchuk. . . . You don’t expect the doctor to be stymied, particularly after extensive testing. But failures to find a diagnosis do occur—and while no one knows exactly how often, 10,000 patients contact Falchuk’s firm for help every year.
Go ahead and read the whole thing.
By Evan Falchuk
The March issue of MORE magazine dedicates its “Medical Mystery” column to the problem of misdiagnosis. Here’s a taste:
Americans believe that diagnosis is the cornerstone of medical care: You go to a doctor, who labels your problem and prescribes a treatment that makes you well. But what if the process gets stuck at the labeling stage? “We have a fantasy that as soon as we describe our symptoms, the doctor will know what is wrong with us. But the reality can be much more complicated,” says Evan Falchuk. . . . You don’t expect the doctor to be stymied, particularly after extensive testing. But failures to find a diagnosis do occur—and while no one knows exactly how often, 10,000 patients contact Falchuk’s firm for help every year.
Go ahead and read the whole thing.
By Evan Falchuk
Bill Gates once said:
Success is a lousy teacher. It seduces smart people into thinking they can’t lose.
It’s clever, and it seems right. Now there is science to prove it.
In a study published last week, scientists studied special imaging scans of doctors brains as they made simulated medical decisions. Those doctors who paid attention to their mistakes made better decisions than those who were more interested in their successes:
“These findings underscore the dangers of disregarding past failures when making high-stakes decisions,” Montague said in a statement. “‘Success-chasing’ not only can lead doctors to make flawed decisions in diagnosing and treating patients, but it can also distort the thinking of other high-stakes decision-makers, such as military and political strategists, stock market investors and venture capitalists.”
This is just the latest proof of how important it is to interrupt your doctor’s decision-making process. Leading researchers in the field of medical decision-making have emphasized how easy it is for “overconfidence” to get in the way. Doctors are neither immune to disease nor the pitfalls of decision-making that plague the rest of us.
By Evan Falchuk
I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work help. A couple of weeks ago, they published their results.
It turns out that in about 90% of cases, it didn’t matter.
By Evan Falchuk
Sometimes you need a published study to tell you what should be obvious in the first place.
This time, researchers have discovered that:
When physicians have more personalized discussions with their patients and encourage them to take a more active role in their health, both doctor and patient have more confidence that they reached a correct diagnosis and a good strategy to improve the patient’s health.
Really?
But wait, there’s more.
By Evan Falchuk
Last night, aboard the U.S.S. Intrepid in New York, a client of ours, Ogilvy, held a moving charitable gala to support their foundation. It’s called Ogilvy Cares, and the night raised money for a remarkable organization called CancerCare, which helps people cope with the realities of life with cancer. Best Doctors was honored at this event for our work against cancer.
The event featured a mini-concert by Jordin Sparks – who was awesome. There was also a performance by a band called N.E.D. (No Evidence of Disease), which is made up of leading gynecologic cancer surgeons from across the country. They rock – and are an amazing story of the power of music to raise awareness of gynecologic cancers.
Below the fold you can read the text of what I said last night.
It reveals a secret: how each of us has the power to fight cancer.
