Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Do we want big medicine or good medicine?

Jordan Grumet, MD
Policy
July 3, 2013
Share
Tweet
Share

If you listen to the pundits, the future of medicine is big: big medicine, big data.  And indeed the healthcare policy of our nation is couched in the promise of what is to come.  Many dictates of the accountable care act focus on the ability to aggregate and consume a variety of inputs. ICD-10, EMRs, and meaningful use all tie nicely into a beautiful computational orgy.

Big data, however, has it drawbacks.  One wonders if in usual fashion, politicians and pundits will do more harm then good.

Correlation and causation

There is a hierarchy in medical data.  Every clinician knows that prospective, randomized, double blind studies are the gold standard.  The reason why, is that lesser models (retrospective and case study), often are only able to show correlation.  Time and time again, we find that clinical decisions based on correlation are faulty.  High homocysteine levels are associated with coronary artery disease but bringing them down with folic acid can be harmful.  Poor dental health may be related to cardiac disease, but good hygiene has little effect on the risk of heart attack.  In a world where the LDL and HDL hypotheses are quickly being disproven, one loses a taste for relying on such logic.

Yet, big data is clearly a correlational model.  One can only compare it to the weakest forms of evidence (case control, open label).  There is no ability to use it in a prospective randomized manner.

Poor studies lead to poor medicine.

Period.

Garbage in, garbage out

I am not a big fan of meta-analysis.  The reason why, is often the bias of the investigator clouds the results.  If you want certain answers, you ask certain questions.  Inclusion criteria can be tricky and bend to the will of those crunching the numbers.

Big data suffers from the same fundamental issues.  Who knows the political pressures that will be placed on scientists.  If you don’t get the answer you want, maybe you have to ask the question differently, query the database more delicately.

Anyone can produce results, but will they be meaningful.

Faulty inputs

For years scientists have relied on death certificates to understand causes of death in America.  But as almost any signer of such documents knows, they are often completed in a hurried, haphazard way.  As a physician, I have no reason to care if the cause of death is correct.  Often, in fact, I don’t even know the answer.  It’s just another paper to fill out: cardiovascular collapse (whatever that means).  A grand majority of times when I review these documents as a medical expert, the cause of death on the certificate is inaccurate.

Big data relies heavily on ICD-9 and CPT codes.  Providers often manipulate these codes, however, for a variety of reasons.  Want the venous doppler to be covered, say the patient has a DVT (of course you don’t know yet because you haven’t done the test).  Want the blood tests to be paid for by insurance, say the patient has fatigue.  The EMR doesn’t have a code the suitably fits the situation, just use another, who cares if it’s not accurate?

Most of the time these data inputs have no real meaning to the clinician and thus only receive a passing thought.  They are another hurdle to providing care, they are to be dispensed with as quickly as possible.

Keeping our eye on the ball

The great task of big data is falling squarely on the shoulders of overburdened clinicians.

ICD-10, CPT, EMR, Meaningful Use, PQRI

ADVERTISEMENT

Inputting all this data takes huge amounts of time, time that is being taken away from patient care.   Years of practice and training has formed clinicians who strive towards perfection.  These distractions destroy our attempts at mastery.

No one would think of asking the conductor of a symphony to also collect tickets at the front door in the middle of a performance.

What is gained in knowledge with big data, is lost many times over in faulty, distracted, and poor face to face care.

Conclusion

We are left with one basic question.

Do we want big medicine or good medicine?

I’m not sure we can have both.

Jordan Grumet is an internal medicine physician and founder, CrisisMD. He blogs at In My Humble Opinion.

Prev

In practicing medicine, offense wins championships

July 3, 2013 Kevin 10
…
Next

Reflections after 4 years of emergency medicine training

July 3, 2013 Kevin 3
…

Tagged as: Primary Care

Post navigation

< Previous Post
In practicing medicine, offense wins championships
Next Post >
Reflections after 4 years of emergency medicine training

ADVERTISEMENT

More by Jordan Grumet, MD

  • The man who changed the world with baseball cards

    Jordan Grumet, MD
  • A hospice doctor’s advice on getting your finances in order

    Jordan Grumet, MD
  • A story of persistence in the face of death

    Jordan Grumet, MD

More in Policy

  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Do we want big medicine or good medicine?
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...