Sunday, February 14, 2010

What is the Most Sensible way to Diagnose, Treat and Prevent Health Problems?

What is the most sensible—i.e., the least costly and most effective—process by which to:
  • Diagnose a particular patient's health problems
  • Treat those problems in order to increase the likelihood of getting the best clinical outcomes (symptom alleviation, blood text normalization, disease elimination, etc.)
  • Help people help themselves (e.g., prevent illness, manage chronic conditions, and deal effectively with psychological distress).
In some situations, this is common knowledge because the problem and remedy are both obvious (e.g., filling a tooth cavity, putting a cast on a broken arm or ice on a sprained ankle, removing a wart, testing a growth for skin cancer, etc.). But in very many situations:
  • A set of symptoms reflect a multitude of possible underlying problems
  • Comorbidity (two or more health problems exist at the same time, especially in persons with chronic conditions) complicate matters greatly
  • There are conflicting (no clear-cut agreed-upon) or inadequate guidelines/protocols/approaches for testing and treating certain conditions (see this link)
  • A person's mental/psychological state is affecting one's physical health (e.g., emotional stress affecting one's immune system) and visa versa (e.g., certain diseases affect one's emotions, thinking and behavior)
  • Medication side-effects and drug-drug interactions may be causing certain symptoms)
  • There is a significant influence of genetic as well as environmental factors
  • …and so on.
The unaided human mind typically cannot make useful sense of this incredible complexity, which is why we have a serious knowledge gap in healthcare (see this link).

What's needed is much more focus on better coordinated research—using both controlled studies and lessons learned from the field in everyday clinical practice—along with much greater use of EHRs and PHRs coupled with advanced decision-support tools. The goal ought to be the development of ever-evolving evidence-based guidelines focused on cost-effectiveness that are presented along a timeline of workflows (do A then B then C…) and/or using validated rules/algorithms based on mathematics and logic, which clinicians use to augment their experience and education.

If the healthcare industry move forward steadfastly in this rational direction, and rewarded providers for delivering high-value care, we'd be transforming our healthcare system in one that truly works.
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