Crowd Wisdom for Diagnosis?

Art Papier MD apapier at LOGICALIMAGES.COM
Wed Jul 17 20:48:02 UTC 2013

Yes clinical decision support, and using tools at the time of action,
instead of relying on memory alone needs to be taught and adopted widely.
Wonderful systems like Dxplain, Iliad, QMR, PKC  were developed 30 years ago
or more, but never widely adopted.  Kahneman asserts that System 2 thinking
is hard and humans don't like to spend much time really thinking and being
analytical.  Humans actually prefer to not use their brain to think, process
and solve!  It is too difficult Kahneman argues, we are lazy and prefer
quick, blink type judgements.  In thinking about diagnostic CDS, we need to
realize that the output of diagnostic CDS cannot increase cognitive burden,
it must make answers more obvious.  So yes we need to create and teach to
systems that help the clinician capacity to remember and process, but we
must focus on the output of CDS, these systems must relieve cognitive burden
and make it easier to see answers.   For anyone on the list that is curious
about a different approach to CDS please visit  VisualDx
has a 98% renewal rate at hospitals, is used in over half of US medical
schools, and over 1500 hospitals and large clinics.   Ten of thousands of
clinicians use VisualDx to assist in pattern recognition and diagnosis.
Here is just one example of how CDS is used in busy work environments  Please feel to contact me
off the list with research questions or collaborative ideas.


Art Papier MD, Logical Images, 

Associate Professor of Dermatology and Medical Informatics

University of Rochester


From: Hoffer, Edward P.,M.D. [mailto:EHOFFER at PARTNERS.ORG] 
Sent: Wednesday, July 17, 2013 2:01 PM
Subject: Re: Crowd Wisdom for Diagnosis?


I would suggest hat rather than trust to serendipity - ie, someone on the
list might have some useful ideas - that doctors with a puzzling case should
avail themselves of computer-based clinical decision support systems such as
DXplain (visit or Isabel.  These have been well-proven to be
useful in improving one's differential diagnosis.




Edward  P Hoffer MD

MGH Lab of Computer Science


From: Peggy Zuckerman [peggyzuckerman at GMAIL.COM]
Sent: Wednesday, July 17, 2013 12:27 PM
Subject: Re: Crowd Wisdom for Diagnosis?

Dr. Zamir's suggestion that doctors who are puzzled by a diagnosis and turn
to this or similar sites could solve some of the errors  that occur.
Frankly, I am more concerned about the doctor who has made a misdiagnosis,
and has no idea that he has done so.


Thus the need for the patient to search out more input into the unresolved
issue.  There is little information on the impact of misdiagnosis, but many
in this community have personal experience with this.  Multiply that tenfold
and you get a sense of the cost to our society.


A friend sums this up in the simple question that floats in the mind of
every frustrated patient, "How do I know if my doctor knows what he is
talking about?".


Peggy Z


On Wed, Jul 17, 2013 at 7:35 AM, Timothy Krohe <tkrohe1 at> wrote:

Agree with Dr Zamir the better utility of posting to physicians-only
services . 


While my goal is not to provide a plug,  this type of assistance happens
regularly on .  In frequent posts,   a physician  describes a
case,  requests help AND usually provides feedback to enhance learning. All
posts are visible to all physicians, so there are glimpses of "how (other)
doctors think".  Access is free to licensed physicians.  The website has
MANY other humor/stress release/political/administrative postings as well so
is not purely clinical and you need to sift for the clinically useful posts.


In the DoD, there is a worldwide teleconsult service that emails requests
for help , often from the outlying combat or isolated bases. A large group
of specialists/internists from the larger military hospitals have
responsibility to respond quickly with comments/recommendations.   Very
collegial and supportive for those docs/corpsmen/NPs/PAs providing care in
isolated area. Access obviously limited to DoD.


I have enjoyed and learned (and I hope helped other MDs) from both systems.
No fees for the reqeuster in either.


TL Krohe MD General Internal Medicine


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