A dermatologist take on the Facebook Kawasaki diagnosis story

The Facebook Kawasaki diagnosis story is a wonderful one. In case you’ve not heard, a 4-year-old boy with a fever and facial swelling was misdiagnosed by his pediatrician. When his mother went to Facebook to share photos of the poor, pumpkin-headed child, three of the mom’s Facebook friends told her that he had Kawasaki disease. They implored her to take him to the ER. She acquiesced and took her son to the hospital where he was admitted for Kawasaki disease, just as they had predicted.

It’s a great human interest story, but also a great example of the value of teams. Drs. Atul Gawande, Peter Provonost and others have been preaching about the power of teams for years. In most instances, they assert, a good team is better than one brilliant doctor. The principle that teams outperform even great talent is vogue in business as well as medicine; it’s even been a hot topic over at The Harvard Business Review.

In this case the team was crowd-sourced. That is, a group of (mostly) lay Facebook users came up with the correct diagnosis even though the physician treating the child had not. This is what the empowered patient movement have been saying all along: “We’re critical members of the healthcare team, not just recipients of care.” And they are.

As a dermatologist, I don’t expect my patients to post photos of their rashes to Facebook for a second opinion, but I do value their and their families’ input about the diagnosis and best treatment. Many times, they are right. “Listen to the patient,” said Osler, “he is telling you the diagnosis.” While Osler couldn’t have imagined patients reading his textbook, today’s patients have easy access to all types of medical information. If Osler were on Twitter today we might MT (modify truism): “Great doctors are great team members, and the patient is part of that team.”

A twist to this story is that one of the Facebook friends, who posited the correct diagnosis, happened to be a pediatric cardiologist. Because Kawasaki disease can lead to coronary artery aneurysms, she was familiar with the disease and treatment. However, by advising the mother to take the child to the hospital right away, this physician gave medical advice to someone who wasn’t her patient. She did so using social media.

Treating someone with whom you do not have a doctor-patient relationship is a violation of medical ethics. This clearly defined relationship protects the patient and the physician: both understand the expectations and responsibilities. In this instance, the outcome justified the physician’s action — failure to treat this child could have been catastrophic. But is this teleological argument the right one? That is, can we say that the ends always justify the means when physicians practice medicine using social media? What if the patient did not have Kawasaki’s disease, yet the mother took him to the ER anyway, costing her lost time, wages and debilitating medical bills? Would the Facebook physician still be justified? Would the physician be accountable? How will we decide what is right and wrong in this wonderful, strange new world?

Jeff Benabio is a dermatologist at Kaiser Permanente in San Diego. He blogs at The Derm Blog and can be found @Dermdoc on Twitter.

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