Could Clinical Decision Support Empower Patients? -- InformationWeek | eHealth - Social Business in Health | Scoop.it
It's time the medical establishment heeded the longstanding
advice of informatics pioneer Larry Weed and used "participatory" diagnostic methods, says editorial.

Neil Versel | March 22, 2013
Ideas long espoused by medical informatics pioneer Dr. Lawrence L. Weed but shunned or ignored by the medical establishment might find a perfect fit in a world of "participatory medicine,"suggests a well-known proponent of patients taking an active role in their own care in concert with healthcare professionals.

As he explained this month at the Healthcare Information and Management Systems Society (HIMSS) conference in New Orleans and in a 2011 book he co-authored with son Lincoln, Weed believes in "coupling" medical knowledge to specific patient problems with the aid of computers. Any attempt to practice medicine based on a physician's knowledge alone invites diagnosis error, according to Weed.

That opinion struck a chord with Terry Graedon, co-editor-in-chief of the Journal of Participatory Medicine. "Recent research reports have shown that misdiagnosis is an Achilles heel for the current practice of medicine," Graedon wrote in a commentary published this week.

[ A study suggests patients don't like it when doctors use computers to diagnose them. Read Clinical Decision Support A Turnoff For Patients, Says Study. ]

Indeed, the Journal of the American Medical Association's JAMA Internal Medicine just last month published a study showing that physicians missed a surprisingly high number of common diseases in ambulatory care. Although Graedon's article does not mention this study, it does raise similar themes.

Proper diagnosis, Graedon argued -- as Weed, creator of the problem-oriented medical record, has been doing for decades -- starts with a complete problem list. Then, a computer system couples problems to specific medical knowledge.

"If diagnosis begins with standardized data collection, doctors bring clinical judgment to bear at the final stage of diagnosis. Treatment should then be evidence-guided but individualized for the particular patient," Graedon wrote. "We trust that at this point the patient would make his or her preferences known and share in the decision," she added, bringing in the element of patient empowerment, because the Journal of Participatory Medicine is a publication of the Society of Participatory Medicine.

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