Share and Share Alike

Clinical teaching

Image by paukrus via Flickr

She looked at me through red-rimmed eyes. Whether from lack of sleep, or from constantly rubbing her frontal sinuses, her eyes were a giveaway that she was ill. “My ears are full, my sinuses are clogged,” she began, “my throat is raw and I can’t stop coughing and this (as she pointed to her head) has been going on for two weeks, so I finally decided to come in.”

As I examined the patient, I tried to decide if this was a simple viral infection or a more severe bacterial infection. The difference is significant: one may need only decongestants and cough medication, while the other may call for the use of antibiotics. Telling the difference is difficult, as office diagnostic testing is frequently not specific enough to separate the two.

If we’re somewhat confident it’s a viral infection, then the next difficult part becomes figuring out the right treatment. Which combination of decongestants works best and for the lowest cost to the patient? Or do they work at all? If these drugs do work, how long do we treat the person? And what do we tell them as to whether they’re at risk of infecting others and for how long?

As the saying goes, there ought to be an app for that. Now, some major health organizations are beginning to understand we can’t base good medical care on one patient at a time. Recently, the Dartmouth Institute for Health Policy and Clinical Practice received agreement from six major clinical systems—Cleveland Clinic, Dartmouth–Hitchcock, Denver Health, Geisinger Health System, Intermountain Healthcare, and the Mayo Clinic—to share data on outcomes, quality and costs of care. They’ve agreed to share information on large programs, such as knee replacement surgery, depression, asthma, weight–loss surgery, spine surgery, and delivery of babies to start.

Unfortunately among health care institutions, this concept of systematically learning from others seems relatively new. Seemingly some health systems believe their way is the best way, or never asked the question—is there a better way? Seven hospitals in Kansas City recently got on the data bandwagon, agreeing to share care strategies that may positively impact direct patient care. This sharing of information has profound implications.

Imagine what it would be like for patients, if a computer could tell us what infections were occurring in our area, and what treatments demonstrated the best outcome for the lowest cost. High–quality, cost–effective medicine based on the real–time experiences of others.

Now that’s worth sharing.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

One Response to “Share and Share Alike”

  1. That’s some good stuff there! Amen to that!

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