Doctors' support for diagnostic decision support tools requires an attitude adjustment

I was dismayed and angry last May when news broke out about Aimee Copeland, a 24-year-old young Georgia woman whose left leg, right foot and hands were amputated because her doctors missed the diagnosis of necrotizing fasciitis for days. Her case highlights the human cost of the deeply rooted cultural resistance by physicians and hospitals to using diagnostic decision support (DDS) software and accepting these tools as part of routine practice.

The news struck close to my heart. Like Aimee, my daughter Isabel nearly died in 1999 when her physicians missed diagnosing necrotizing fasciitis, leading me to start my own company, which develops DDS software that would help clinicians recognize diseases more quickly. DDS software generates a checklist of possible diagnoses and flags high-risk ‘don’t miss' diagnoses when users enter a patient’s symptoms. The tool is available for PCs, smartphones and tablets.

There is no doubt in my mind that Aimee could have been diagnosed earlier had our or another DDS application been used by her doctors.

DDS systems, some even now available as mobile apps, would have immediately brought the flesh-eating bacteria to clinicians’ attention if they had just been able to enter the young woman’s symptoms (i.e., leg cut, vomiting and intense pain) into them. In fact, necrotizing fasciitis would have been the first or one of the top possibilities.

Unfortunately, few hospitals have implemented DDS. This is because many health institutions and clinicians do not perceive that they have a problem with diagnosis, in spite of a vast body of research showing that 10 percent to 20 percent of all diagnoses are wrong. What’s more, they are not legally obligated to measure or report diagnosis error, so most deal with them at the settlement or lawsuit stage. Fortunately, and tragically, almost all diagnostic errors are preventable – just like Aimee’s.

Lack of a perceived need also means that there is persistent physician resistance to using diagnosis decision support tools, and here’s why: Doctors rate themselves on their ability to diagnose patients. Many believe others make diagnostic errors, that it won’t likely happen to them, and that DDS takes away from using their expertise and judgment.

Becoming a fully trained physician is a long and arduous task. Eleven to 15 years are invested in education and training, and physicians understandably aspire to apply their knowledge acquired in medical school and residency. But doctors − and hospitals − must realize that DDS is a tool designed to support, not replace, their diagnostic skill and clinical judgment. As demonstrated in countless other professional disciplines, people become smarter when they embrace and use technology wisely and those who do not, eventually, just get left behind.

The healthcare system puts unbelievable demands on physicians; however, if physicians adopted, used or demanded DDS from facilities, they would find that the tool would dramatically alter the dynamic of patient care and care delivery for the better. Consider what a mobile DDS app could do for doctors and nurses:
• It would give them immediate and faster access to medical information than if they had to seek out a computer at a central nursing station.
• It would provide the ability to check differential diagnosis, change the outcome of care, minimize liability risk and have the world’s entire medical knowledge at their fingertips. Clinicians wouldn’t have to worry about remembering and keeping up with the latest medical research – which is impossible anyway, due to the sheer volume of peer-reviewed studies published weekly in scores of medical journals.
• Moreover, with more than 12,000 diseases reportedly worldwide, it is, again, humanly impossible for any doctor to absorb and recall all that knowledge instantaneously.

For all those reasons, physicians and nurses should reassess their views of DDS. It’s a practical solution to help prevent missed or delayed diagnoses. It is inexpensive, easy to use and yields a huge return on investment.

More importantly, DDS is all about patient care. The earlier a doctor can diagnose and treat the problem, the better the outcome. What happened to Aimee is a powerful wake-up call: DDS must become a standard of care.