Gregory Patrick, MD
Potential Financial Conflicts of Interest: None disclosed.
Patrick G.; Risk Prediction Versus Diagnosis: Preserving Clinical Nuance in a Binary World. Ann Intern Med. 2009;150:223. doi: 10.7326/0003-4819-150-3-200902030-00023
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Published: Ann Intern Med. 2009;150(3):223.
TO THE EDITOR:
Vickers and colleagues (1) neglected to mention the greatest impediment to implementing predictions: Physicians practice in a binary world driven by diagnosis. Those who pay for health care profit from risk management and care little for clinical nuance. A diagnosis of hypertension has a direct impact on the premium that a patient will pay for health or life insurance—whether the hypertension is benign (International Classification of Diseases code 401.1) or malignant (code 401.0). A diagnosis of depression can make disability insurance unobtainable. A diagnosis of asthma can disqualify a patient from employment or from serving in the military, no matter how well the asthma is controlled. Computers are binary machines. An electronic medical record demands that specific diagnoses with fixed end points be entered into the computer. Computerized algorithms are routinely used to determine “medical necessity” and “quality care.” Woe betide the patient who falls outside of the algorithm.
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