22nd July 2015

Diagnostic Dilemmas

Pre-R makes sense for low hanging fruit. Lacerations, UTIs, ear infections, rashes… Why should coders, billers, collectors, insurers, governments step in between a person needing a simple medical solution and someone offering that solution?

Applying convoluted systems to non-emergent conditions is costly, wasteful and impedes care for those who face true emergencies. As I’ve typed before, car insurance shouldn’t get involved with scratched paint, blown headlights and oil changes.

Admittedly Pre-R is cherry picking. But it is my favorite systemic way to address one aspect of the medical spectrum. It’s not sexy medicine, but in a world where people have $5,000 deductibles, it’s critical.

The medical spectrum ranges across these:

Preventive/elective (mammograms, vaccines, mole removal, Botox)
Easy diagnosis / easy treatment (cellulitis, UTI, abscess, laceration)
Easy diagnosis / difficult treatment (crushed pelvis, atrial fibrillation)
Difficult diagnosis / easy treatment (“Fragile X-associated primary ovarian insufficiency”… see CrowdMed.com)
Difficult diagnosis / difficult treatment (fibromyalgia, chronic fatigue, Pick’s disease, Creutzfeldt-Jakob disease)

Pre-R addresses some of the first category, but mostly the second. Hospitals do well for the third. A recent ER patient of mine, however, made me realize inventions are still needed to help the fourth and fifth.

My patient appeared in the ER feeling unwell following a recent brain MRI and multiple visits to a neurologist. I checked blood tests, ruled out life threats, talked with the patient’s neurologist and referred back to his office the following day. A couple weeks later the patient found a new neurologist, and was volleyed back to the ER (finding me yet again) for a repeat MRI of the head + neck this time, both of which showed nothing new. Now past 5pm, I spoke with a third on-call neurologist, who suggested we were nearing the end of the neuro line, and perhaps it was time to board the psychiatry train. The patient was sent home again with no diagnosis, ongoing symptoms, printed MRI reports and plans to revisit the 2nd neurologist the next day.

Pre-R offers nothing here, but perhaps this might? Have a look at CrowdMed.com. It addresses diagnostic dilemmas and I love the concept. Maybe it could help you?