DOC-IN-A-BOX

A small study, unlikely to garner much media attention, may be one of the first salvos in the war against medical waste.

Recently published in Circulation: Cardiovascular Imaging, the trial studied the impact a web-based computer program might have on decision-making in the emergency room. About 500 patients presenting with chest pain or a sensation of shortness of breath, something doctors call dyspnea, were randomized to an active group that had a computer gauge their medical risk and prescribe the necessary testing. The doctors in the control group decided in the usual fashion, without computer help. The investigators found that the program lowered the patients’ radiation exposure (i.e., fewer tests) without a significant difference in the rate of return to the emergency department for care or occurrence of adverse events.

Watching the geometric progression of technological evolution, it seems inevitable that someday the line will be crossed where computers become more accurate diagnosticians than people. Whether you believe that day is 25 years away, 50, or 100, is irrelevant. The importance of this study lies in the fact that, properly applied, even present-day computer programs have the potential to cut waste (and increase patient safety).

Whatever your view of Obamacare, it is evident that universal coverage and no exclusions for pre-existing conditions are good things. It is also evident that good things come at a cost. The only immediate way to get a good thing at no cost is by removing fraud and waste. Having practiced in the medical field for decades, my impression is that there’s probably a lot more waste than fraud. Figures of 20-30% of our medical care dollars have been bandied about, which jives with my admittedly subjective impression.

Eventually, the march of technology and knowledge will lower costs in other ways, by allowing more effective treatments and perhaps even curing chronic illnesses that, at present, we can only effectively manage to the point of bankrupting the health care system. In the meantime, it behooves us to put a lot more effort into studies like the one above, the primordial germ of artificial intelligence, that will ultimately make my job obsolete.

Someday, perhaps sooner than we think, the only “doc-in-the-box” you’ll ever need will be attached to a touchscreen with circuits linked to what is now known as the “cloud.”

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