Does Every Patient Need Every Test? Tips4EyeDocs Daily – 03 Feb 2012 – No.43

In the last year, I attended almost 30 hours of continuing education.  What struck me is the love of technology by most, if not all, lecturers. The audience, however, during the breaks weren’t so eager or enthusiastic. Are we creating an artificial standard of care that is mainly driven by technology vendors? .

Of course, I don’t think so, but I believe doctors across the nation are uneasy about an “arms race” in technology that seems more inclined to be competitive than actually benefiting the patient.  Vehemently, the proponents of technology will castigate those who or demur towards a heavy investment or dependence on technology for clinical decision making.

There was once a standard called the “80/20” rule that was common in laboratory and imaging medicine. If a doctor had more than an 80% probability of a diagnosis or less than a 20% probability of arriving at a diagnosis, then more physical examination was necessary before launching into extensive testing. What I see, though, in online eye-only social networking forums that there is a blanket recommendation that no clinical decision can be made without extensive technology use.

I think our own clinical self confidence or self doubt may also play a part.  If we are positioned against other clinicians of other specialties, there is always a potential for trying to compare one’s self with another.  But only with clinical experience and exposure and the willingness to make a mistake and recover can a clinician grow. That means clinicians who are not infallible must be willing to make a mistake. Hopefully, our clinical protocols will not make that mistake a dear one nor make the patient harmed by our mistake.

Fortunately, in eye care most clinical problems that are daunting or challenging are slowly progressive. That means that bringing the patient back for follow up will lessen the morbidity of any actual clinical decision making.  This should minimize the “damage” that a single clinical mistake may bring to a patient.

I’m not a detractor of high instrument technology. Nor am I complete devotee of it.  I believe that a doctor should not be judged on merit by how much instrument testing is done. Unfortunately, our litigious society does control somewhat the behavior of doctors and this is what society has wrought on itself in its quest for infallible medicine.

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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