By Art Papier
November 20, 2008 | Studies show that nearly 20 percent of all medical diagnoses and 60 percent of prescribed treatments are incorrect. Mistrust of the United States health care system and the economic impact of medical errors are considerable, creating less-than-optimal outcomes for patients and costing millions of health care dollars every year. Given that Medicare will no longer reimburse hospitals for errors deemed preventable, it is more critical than ever to avoid unnecessary errors.
Just as patients go online for health information, the Internet has also become a go-to diagnostic source for physicians. Physicians are replacing old, outdated reference books with software tools that provide up-to-date information for accurate diagnoses at the point of care. Whether suggesting a diagnosis or a treatment, these tools can be invaluable in reducing the number of diagnostic errors.
Given that half of all diseases present with a visual marker, and 10 to 20 percent of a general practitioner’s clinical diagnoses are visually based, visual diagnostic decision support (VDDS) can be a tremendous help to a physician in diagnosing an illness. The textbooks and atlases that the prior generation of physicians consulted often showed only classic or severe cases on fair-skinned individuals.
This is inadequate, as diseases present differently depending on the patient’s age and skin tone, the disease stage, and other factors, and can lead to a misdiagnosis. Unlike atlases, the VDDS is searchable by patient findings, which leads to a near immediate patient-relevant differential diagnosis, comprehensive medical images, and concise and regularly updated clinical information.
This transition to evidence-based visual diagnostic decision support is positively impacting the physician-patient relationship. With the VDDS system in place, patients perceive their physicians to be delivering higher-quality patient care and have more confidence in the diagnoses their physicians have concluded. Furthermore, when patients can see actual medical images that represent the diagnoses they are seeing on themselves, they have a greater sense of satisfaction and comfort in knowing they are not the “only one.”
By using professional resources not found freely on the Internet, physicians are instantly communicating to patients that they are taking the extra time to explore all possible diagnoses from a trusted source.
For example, consider the following: An adult female visits her primary care doctor with bilateral leg swelling, and her legs have been weeping for days. She is diagnosed with cellulitis and started on oral antibiotics. After a few days on the medication with no improvement, she is sent to the emergency department for admission for IV therapy for cellulitis.
The patient spends five days in the hospital with no significant improvement, and by this time, she has received eight days of total therapy and is experiencing increasing anxiety about her condition. A physician enters her signs and symptoms (findings: obesity, bilateral, leg, and weeping) into VDDS software, and a variety of conditions are presented and sorted by greatest relevance to the patient symptoms. A diagnosis of stasis dermatitis is identified and is validated with an image that looks extremely similar to the patient’s legs.
The VDDS system suggested that the physician consider an alternative diagnosis. The system also delivered specialist-level treatment knowledge of the condition, and the patient was treated appropriately. With the appropriate therapy, the patient’s legs rapidly improved, and she was released from the hospital only two days later.
Complications of stasis dermatitis include infection and ulceration, and people suffering from venous diseases—particularly when the condition has been misdiagnosed—often experience depression and anxiety.
Using a VDDS provides physicians with early and accurate diagnosis, which can save time and money. Additionally, a VDDS can help avoid the administration of unnecessary antibiotics and improve outcomes for the patient, both physically and emotionally.
Art Papier, M.D. is CSO and founder of Logical Images, and an Associate Professor of Dermatology and Medical Informatics at the University of Rochester School of Medicine and Dentistry.