Health IT, Patient Engagement

CHIME: Ask for a diagnosis, not just a medical test

Dr. Leana Wen speaks at CHIME15Medical technology is great, but overused. Information technology, especially data, is underused, in the opinion of Dr. Leana Wen, health commissioner for the City of Baltimore.

Speaking at the College of Healthcare Information Management Executives‘ Fall CIO Forum Thursday in Orlando, Florida, Wen noted that the recent, groundbreaking Institute of Medicine report on diagnosis error found that as many as 30 percent of medical tests are unnecessary. But the prevailing fee-for-service paradigm as well as the fear of litigation incentivizes testing and the use of new, expensive technologies.

“I tell my patients to ask for a diagnosis and not for a test,” said Wen, an emergency physician, Rhodes scholar and author of “When Doctors Don’t Listen: How to Avoid Misdiagnosis and Unnecessary Tests.”

The initial diagnosis then should serve as starting point for a conversation that, with technology, can help clinicians, in concert with patients, arrive at a final, accurate diagnosis. “If we end up jumping straight to testing, we’re just shotgunning,” Wen said.

This is where data and patient empowerment come in. “Healthcare is no longer about hospitals,” Wen said, making a statement that is obvious to anyone in healthcare.

Patients get care in all sorts of places, including their homes, which is why Wen encouraged the industry to invest in telemedicine as a way of promoting access to care and avoiding unnecessary visits to the emergency room or even the doctor’s office. This, according to Wen, moves healthcare beyond just sick care.

Patients can only be empowered if they know to ask questions and they have access to their own health information, however. Wen gets frustrated when healthcare organizations wrongly cite HIPAA for refusing to give patients copies of their medical records.

“This is the bane of my existence now. People use HIPAA as the excuse for everything,” Wen said.

Communication is another area of healthcare in dire need of improvement. Wen told a story about a patient who filed a complaint about his care in the ER even though the patient supposedly had a good outcome. “He does not recall ever finding out that he was having a heart attack until he was getting discharged for the hospital,” Wen said. But the man was catheterized and his wife was left waiting for more than six hours before finding out he was in the cardiac care unit.

Wen surmised that the patient either was groggy from the episode or that a physician used too much medical jargon in explaining what was happening. “Maybe we should be thinking about the effect of our terminology on our patients,” she said. “We really need to make sure we are engaging our patients as equals.”

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