Don’t forget the patient when using algorithms in their care

The common thought among health reformers is that we spend too much on care, and the additional care patients receive doesn’t necessarily help them.

What inevitably follows is a discussion on how to streamline care, yet maintain quality. To that end, most hospitals and emergency rooms are using algorithm-based care based on the best available evidence. Where doctors actually had to hand write admission orders, they are now checked off – like a menu at a restaurant.

But sometimes diagnosis requires more nuance. How do you know, for instance, that the patient really has pneumonia as you’re running down the pneumonia checklist? That’s a question that Stanford physician Abraham Verghese asks as well:

Indeed, the push for efficiency and “quality” has every hospital touting “pathways” and “algorithms” for the treatment of pneumonia. And with the focus on “outcomes” research we will probably be saddled with more pathways and algorithms. It is commonplace to see patients being wheeled down the “pneumonia” pathway and meeting all the quality and other metrics that measure a hospital’s efficiency, only for me to disagree with the label of pneumonia. Diagnosis matters. Patients would concur, even if we seem to have forgotten.

But in a difficult financial environment, hospitals are making business decisions to emphasize efficiency and cut costs. And that sometimes impedes diagnosis, like a decision to move a microbiology lab off-site.

So let’s slow down before completely embracing algorithm-based medicine, or as Dr. Verghese writes, “Let’s give ourselves a chance at precise diagnosis before we treat. That means good specimens, hand carried, examined by the people who care for the patient.”



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