Thursday, December 29, 2005

Top ten issues in hospital medicine for 2005

As the year draws to a close I will be writing a series of posts on the major issues of the year in the field of hospital medicine. Disclaimer: This list reflects solely the biases of a committee of one (me). The reverse numerical order of posting does not necessarily reflect the order of importance. I have blogged about some, but not all of the issues before.

Issue 10: The diagnosis of pulmonary embolism.

The long awaited results of PIOPED II were announced at the close of last year at the Radiological Society of North America national meeting. There was also some discussion of the results at Chest 2004. To the best of my knowledge the results have not yet been published. Despite hopes that CT would emerge as the clear diagnostic modality of choice the PIOPED II results suggested otherwise: the best approach is individualized, and usually based on the integration of multiple modalities and clinical data. I presented my thoughts on the issue earlier this year. That post has more information on the PIOPED II findings, which will not be repeated here.

I think Gregory S. Martin, speaking about PIOPED II at Chest 2004, sums it up best: Based on these results, the use of PE-protocol CT cannot be advocated as a stand-alone procedure for diagnosing PE.


Ward Merkeley,M.D. said...

Today an article titled" Googling for a diagnosis-use of Google as a diagnostic aid: internet based study" appeared in the November 10 issue of the BMJ, British MedicalJournal.

The article's authors , Hangwi Tang and Jennifer Hwee Kwoon NG, discuss the success of using Google search to diagnose patients by putting in their signs and symptoms(3-5).

The diagnostic cases(26) were taken from the New England Journal of Medicine 2005.

The results were impressive. What the Google search found were numerous revelant articles and citations which when read by physicians could selected the correct diagnosis 58% percent of the time.

Currently, the searches are performed by typing in multiple signs and symptoms, ie,

sore throat, rash,.... fever, etc.

Some shortcomings were noted. For one, searches were less likely in complex diseases with non-specific symptoms or " common diseases with rare presentations."

One can anticipate various ways to increase the accuracy of diagnosing:

- input of vital signs: HR, T,BP, O2 sat
- input of lab values
- input of signs and symptoms in appearance order
- imaging study results

This paper shows there is a tremendous interest in medicine in using Google as a search tool in the diagnosing and possible care of patients.

One can imagine the benefit to young doctor in developing country who now have access to a grand medical library in their hands.

Ward Merkeley, M.D.
Spokane WA

Anonymous said...

Dr R.W
There continues to be alot of discussion in the BMJ about googling for a diagnosis. When google walks into a room, people look up and have lots of different reactions and thoughts.
Using the internet for medical purposes is rapidly evolving. Many professional are using it in novel ways or just trying it out.
Using the internet as a source for medical information in developing countries with no medical libraries or textbooks is
going to be huge.
Just imagine having a database of standard xrays and MRI for radiology students to look at.
The attitudes about using the internet will always be relative. If you are working in a large emergency room and have a question, you might call one of the attending about tularemia details, but if your in a very very small community in Spain working, you might find a link to the internet priceless?

Ward Merkeley,M.D.