Monday, February 10, 2014

A Wild and Crazy Idea: Why Not Verifiable, Virtual, Data-Based, Doctor-Confirmed, Accurate Diagnoses  by One Primary Care Doctor in One Setting at One Sitting?

You see things and you say,”Why?” But I dream things that never were; and I say, “Why not?”

George Bernard Shaw (1856-1950). Back to Methuselah (1921)

I have this wild and crazy idea.

Why not combine five ideas  I’ve either developed or written about into one idea that allow a single  primary care physician  to make an accurate diagnosis during a single patient visit?

Why not tell patients the relative state of their health compared to an ideal state of health?

And why not let the patient leave the office with a record in hand of the diagnosis and the treatment plan?

These five ideas , which I have either developed personally or written about or described in my blog are:


      A patient generated  narrative history entered on the computer by the patient  at his/her home or in the reception room based on the patient’s chief complaint,  age, sex, chief complaint, symptoms, medications, and social and family history  This history is called the and has been widely used for over 15 years. It is used at the Mayo Clinic.  In essence, it is a computer interview of the patient, before he/she sees the doctor in the examining room.


A differential diagnosis based on patterns of abnormal laboratory tests.  I developed this in the 1970s in Minneapolis at a commercial  laboratory. When multiple abnormal tests were present, the top 10 list of diagnostic possibilities contained the precise diagnosis 80 % of the time.


3  A health quotient, HQ, normal range. 80 to 120, based on the patient’s physical measurements – blood pressure, pulse, height, weight, waist  and hip circumferences,  blood chemistries, and a past personal or family history of heart attacks or strokes. This helps patients understand their relative health and how to objectively improve it.

F    Four

4 A cardiac-pulmonary evaluation based on the work of exercise physiologists at SHAPE (System of Heart and Pulmonary Evaluation) Medical Systems in St. Paul, Minnesota.     This system, which has been tested and validated at the Mayo Clinic,  detects  presence of coronary disease, heart failure,  and obstructive lung disease, which together account for 50% of health costs and are leading causes of death in the U.S. Using a risk-free gas exchange device,  which  does not require a treadmill and which consists of cardiovascular leads, a snorkel device for capturing normally exhaled breath gases, and software containing metadata on thousands of patients,   a primary care physician can tell patients whether they have heart or lung disease and their chances of hospitalization or death.


A solo primary care physician,  practicing out of one room with one medical assistant,   can evaluate the integrated  software printout generated by the output of events #1 through #4, examine the patient,  and confirm  the validity or lack of validity of what has been found,  and  make an accurate diagnosis. 

This diagnostic scenario may sound wild and crazy, but  I believe it will ease the problems of  underdiagnosis and overdiagnosis said to be common in today’s rushed medical world.  

Tweet:  This blog post describes a  systematic approach to diagnosis using common sense software in a primary care physician’s office.


1.      Richard Reece, Chapter 34, “An Innovator’s Personal Experience and Vision,” Innovation-Driven Health Care: 34 Key Concepts for Transformation, Jones and Bartlett Publishers, 2007.
2.      .  Richard Reece,  “Testing for Cardiopulmonary Insufficiency in the General Population,"   Medical Innovation and Health Reform Blog.  July 26, 2009.

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