dispatches from the new world of work

"Scan" or "Scam"?

"'A patient comes in because he's in pain,' said Dr. Nelda Wray, a senior research scientist at the Methodist Institute for Technology in Houston. 'We see something in a scan and we assume causation. But we have no idea of the prevalence of the abnormality in routine populations.'"—Science Times/New York Times, 1209.08, "The Pain May Be Real, But the Scan Is Deceiving"

As I've said again and again (piggybacking on the "evidence-based medicine" "movement" championed by the likes of Michael Millenson and the peerless Dartmouth Institute for Health Policy and Clinical Practice), there's a lot that goes on in medicine, even in the most hallowed halls (especially in the most hallowed halls?), that has no basis in fact or hard evidence. This telling-frightening article is one more compelling example of medical witchcraft (sorry to use such strong language); and one more good reason to avoid hospitals whenever you can; and one more reason to question-the-living-bejesus out of any test the doc wants to perform; and one more reason to take charge of your own treatment—for God's sake, grow up, the guy in the white coat is flying blind half the time.

One growing response to the above, fostered by Web 2.0 and social networking, is patient involvement. BusinessWeek (12.15) offers "Can Patients Cure Healthcare?" Discussing websites such as PatientsLikeMe.com, sometimes collectively called "Health 2.0," the article explains that some groups of patients are going so far as doing their own clinical trials. Mounting health-establishment pushback is clear evidence that these increasingly informed patients, even when they get it wrong, are up to something good!

Tom Peters posted this on 12/10/08.

Comments

I picked this up a day too late. Yesterday I accompanied a friend to the local VA. He has been in serious pain for months and they continue to test and test and re-test. Nothing. One full day.

We learned more from the (literally) hundreds of people in the various labs and waiting rooms than we learned from the 10+ professionals that saw us. Several were interns; they were very much flying blind.

Posted by Kate at December 11, 2008 8:55 AM

Tom - You and I both know the most effective treatment and continuing care is where there is a real and genuine, respectful, partnership between doc and patient. I have a friend who is a Vascular Surgeon. He loves it when patients come to him for a consultation if they bring with them the latest ‘Google generated report’ on a particular condition, treatment or drug. He likes that for two reasons. First, the patient is clearly motivated to research and second and more important - he has to be bang up-to-date, well read and briefed and on his toes to be ahead of the patient. So patients are actually ‘teaching’ doctors everyday. More power to patients as I've said for the 38 years and counting of my healthcare career

Posted by Trevor Gay at December 11, 2008 2:11 PM

Reading with interest from Scotland where I lead a National Health Service organisation. I agree with the ideal of patient empowerment and web 2.0 as a solution to sustainable health care.
Are there health care systems out there can we can learn from? To what degree are there digital health care records with remote health care delivery. I have a group of colleagues who want to move in this direction quickly but need to find some clinical "friends" to collaborate with. Here are our ideas to date- http://digitalhealthscotland.blogspot.com/
Enjoyed your blog.
Drew

Posted by drew fowlie at December 14, 2008 6:27 AM

Tom,
Great article. The frightening thing in healthcare today is that we have very little insight into what moves the needle for any particular patient. Clinical trials may be a gold standard, but highly selected trial populations in controlled tests are hardly representative of real world impact on real people.

Just as auto industry efficiencies emerged from Japan, rather than Detroit, we must expect a new way of practice to emerge from somewhere other than the hospitals now incented to "do more" rather than "deliver more". There's a great example at Virginia Mason that a focus on efficiency is akin to slitting one's own throat.

Having wandered the hospital and insurance halls while at McKinsey, I've seen enough to know that, just as with Detroit, efficiency is not in their DNA and savings will not start here.

My bet (and my venture, HealthShoppr.com) is on the fragmented spaces that look to optimize health before urgent measures are required--diet, exercise, bodywork, mental health, etc. Identifying and amplifying effective, personalized, high value solutions in this space will be the growth vehicle that brings the conversation back from power/sexy rescue technology to lean, efficient, low-drama healthy living.

Posted by Vijay Goel, M.D. at December 17, 2008 3:57 PM

After 28 years of medical practice, I agree the more reliable medical information one can ingest, the better.

Even with information overload rampant these days, I think the empowerment of medical knowledge for individuals is a grossly underused tool for lowering medical costs and better health care.

Hospitals are great places for really sick people, otherwise your odds of coming out better than you went in are debatable. viagra with overnight shipping

And don't believe every headline you read without getting the real scoop and perspective. This has become the mission of my website, magazine and blog.

Posted by James Hubbard, M.D., M.P.H. at December 20, 2008 6:43 PM