Internet's Residency Exam (Regina Maria Healthcare Network Case)

Solomonides, Anthony ASolomonides at NORTHSHORE.ORG
Sat Jul 13 17:00:34 UTC 2019


I participated in a large PCORI-funded study of antibiotics in childhood led by Jason Block at Harvard Pilgrim. The emphasis in the study was subsequent weight gain, but the study did use focus groups to consider the issue of antibiotic prescriptions, often for likely viral infections. The problem does not appear to be so much one of misdiagnosis but one of anxious parents, distressed children, and doctors out of time to give adequate advice.

Tony


Anthony Solomonides, PhD  MSc(Math)  MSc(AI)  FAMIA
Director of Biomedical Research Informatics
Research Institute
NorthShore University HealthSystem
1001 University Place, Evanston, IL 60201


224-364-7497



On Jul 13, 2019, at 10:09 AM, HM Epstein <hmepstein at GMAIL.COM<mailto:hmepstein at gmail.com>> wrote:


<imagecb4ba6.JPG>

Thank you so much for this report. It’s truly fascinating. This statistic caught my eye: “A further 13% of prescriptions were given for incorrectly initiated treatment (i.e. for non- bacterial diagnosis) at the emergency depart- ment or by other specialists”

That seems to be a high percentage of diagnostic error by emergency department doctors and specialists even though the report is not about diagnostic error. We have a similar problem in the US with inappropriate antibiotic use, despite the fact that our patients can’t order them for themselves.

Best,
Helene

      [https://drive.google.com/uc?id=0BzqkjTYl6PKwNUhEU2NyZ2RsNW8&export=download]
Website<http://hmepstein.com/> Twitter<https://twitter.com/hmepstein>
LinkedIn<https://www.linkedin.com/in/helenekepstein/>
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On Jul 13, 2019, at 3:16 AM, traian at mihaescu.eu<mailto:traian at mihaescu.eu> wrote:

The official report ”Antimicrobial Resistance: Lessons from Romania”
https://epha.org/wp-content/uploads/2017/06/In-the-red-zone-EPHA.pdf states

”Romanians’ knowledge about the appropriate use of antibiotics is below the European average:

....of all antibiotic prescriptions, a large proportion are given after a consultation with the family doctor: 34% for children and 22% for adults. Those requesting a prescription for antibiotics only after initiating the treatment themselves made up 20%. A further 13% of prescriptions were given for incorrectly initiated treatment (i.e. for non- bacterial diagnosis) at the emergency depart- ment or by other specialists. 11% of patients had received prescriptions for treatments from the pharmacy, without medical consultation.”

So 1 in 5 Romanian patiens ”only” initiates treatment themselves and I have no data how many of them after consulting DrGoogle. In my personal experience (subjective!) patients which cosulted Internet are active patients, ask for more information and clarification, know more details about adverse effects..and so on. This deserves a serious study..

Dr Traian Mihaescu
Clinic of Pulmonary Diseases
30 Dr I Cihac St
Iasi 700115, Romania
www.ispro.ro<http://www.ispro.ro/>
@tmihaescu

On 2019-07-13 01:44, HM Epstein wrote:
Thank you for joining in Traian Mihaescu:
We need your point-of-view. Is this really an issue for Romanian
healthcare or is it just a clever advertising campaign? And if true
then are people self-healing themselves to the emergency room?
Best,
Helene
Website [2] Twitter [3]
LinkedIn [4]
​ Facebook [5]
On Jul 12, 2019, at 2:24 PM, Traian Mihaescu <traian at mihaescu.eu<mailto:traian at mihaescu.eu>>
wrote:
However, at least in Romania, Google could be better than the state
health system... Maybe (=to be sustained by data! study needed!)
patients can have benefits consulting Google than the local health
system...
Traian Mihaescu
Clinic of Pulmonary Diseases
Iasi, Romania
www.ispro.ro<http://www.ispro.ro/> [6]
On 2019-07-12 18:04, Ed Hoffer wrote:
The key here is that doctor (or patient) plus artificial
intelligence
may often be better than without AI, not that one replaces the
other.
Edward Hoffer MD
Sent from my iPhone
On Jul 12, 2019, at 10:34 AM, Sherrill Franklin
<sfranklin131 at gmail.com<mailto:sfranklin131 at gmail.com>> wrote:
Dear Karen,
Of course, using the internet for diagnosis is almost never
optimal
for patients.  But it is often the only resource for those who are
extremely ill and desperate after visiting one doctor after
another
without getting help. I trust your article is constructive and not
intended to disparage patients who have often faced enough
ridicule
in the doctor’s office.
Best regards,
Sherrill Franklin
—Undiagnosed 10 years, $50k out of pocket, 22 doctors including
5
endocrinologists (some at academic medical centers)—none of whom
ran a full set of labs/ Finally went into AFIB, taken to ER,
diagnosed with Hashitoxicosis (Graves/Hashimoto’s)
129 E. Harmony Road
West Grove, PA 19390
610-869-4234
On Jul 12, 2019, at 8:53 AM, Karen Davis <kdavis at LAMMICO.COM<mailto:kdavis at LAMMICO.COM>>
wrote:
Thanks, Helene. That was great. I’m writing an article about
patients using the Internet for diagnosis, and I hadn’t seen
this.
Karen
KAREN K. DAVIS, MA, CPHRM
LAMMICO
CME/CNE Writer and Editor
Risk Management Department
kdavis at lammico.com<mailto:kdavis at lammico.com>
(504) 841-2736 Phone
(800) 452-2120 Ext 1736 Toll Free
(504) 841-5312 Fax
One Galleria Blvd., Suite 700
Metairie, LA 70001
www.lammico.com<http://www.lammico.com/> [1] [1]
FROM: HM Epstein [mailto:hmepstein at GMAIL.COM]
SENT: Thursday, July 11, 2019 6:53 PM
TO: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
SUBJECT: [IMPROVEDX] Internet's Residency Exam (Regina Maria
Healthcare Network Case)
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In Romania, they had a problem that patients didn’t visit their
doctors when they felt ill. Instead they would Google their
symptoms, go to the pharmacy, get the medications Dr. Google
suggested (one big difference between the United States and other
countries), and treat themselves. Of course, a good percentage of
them ended up in the emergency room.
While we encourage patients to become knowledgeable about their
diagnoses, the process and potential treatment plans, none of us
would suggest that they also choose their own medicines and
oversee their own treatment.
This brief but fascinating video shows how one healthcare system
in Romania decided to address that problem. They challenged
Internet visitors to take an “open book“ medical residency
exam, the exact exam their doctors have to take. Enjoy.
https://youtu.be/lkgk9zGz5ro
Best,
Helene
Website [2] Twitter [3]
LinkedIn [4]
​
Facebook [5]
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