Saturday, June 7, 2008

Reece, persnal musings - Clinical Pathology Innovations

Seek simplicity and distrust it.

Sir Alfred North Whitehead (1861-1947), Adventures of Ideas

What do simple folk do?
They must have a system or two.

Lyrics to “What Do Simple Folk Do?” CamelotAs a clinical pathologist, I believe in the simple things.

I believe

• In the power of the clinical mind to sort through relevant diagnostic possibilities at the point of care.

• In enhancing those powers that translating abnormal numbers into diagnostic possibilities.

• In the power of the Internet to generate lists of likely diagnoses, given patterns of abnormals, and age, gender, and chief complaint of patients.

• In the power of “chunking,” building larger diagnostic systems out of simple systems that work.

• In the power of commonsensical algorithms to predict health status based on a brief family history, age, sex, lipid values, blood sugar, height, weight, blood pressure, waist size.

• In the right of ordering clinicians to request and control the diagnostic information they receive. .

• In the concept that simple things are always more complex and risky than they seem but that does not mean the simple things should not tried.

I believe in these simple ideas and systems because I have done them in the real world in the laboratory. Further, I believe in an ideal world, it should be the duty of clinical pathologists to explore the health and disease implications of the information we generate.

In the 1970s and 1980s, our laboratory

• Attached paper slips called Diagnotes to abnormal results.

• Developed differential diagnoses based on age, gender, and abnormal patterns with the right diagnosis appearing in the top 5 possibilities over 80% of the time. With additional simple clinical information, I believe this 80% figure would climb to 95%.

• Suggested relevant follow-up studies.

• Predicted health status, the HQ, normal range, 75 to 125, on thousands of patients.

• Issued more than 6 million reports using these systems.

Why are these simple things not done on a larger scale?

• The mindset that the clinical pathologists’ duties stop at the lab door with issuing of a report.

• The mindset that using the Internet costs too much money in a competitive environment.

• The mindset that diagnostic information listed, not pursued, or ignored may result in lawsuits.

• The mindset that the problems inside the lab outweigh the opportunities looming outside.

I may be wrong, as I often am, but these are my simple-minded views which I express in more detail in my book Innovation-Driven Health Care: 34 Key Concepts for Transformation (Jones and Bartlett, 2007).


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