Ralph A. Highshaw, M.D.

Jenara Nerenberg wrote an article related to doctors needing electronic alerts to remind us to perform correct procedures based on a study from Kaiser Permanente. She discusses the use of medical alerts integrated into the EMR (Electronic Medical Records) used by the physician to remind him or her to order or not order a test based on evidence- based medicine. The test in particular was a D-dimer test used to diagnose blood clots, which has a high false-positive rate. This means that the test over diagnoses blood clots as being present when in actuality it may not be. Hence, this would infer over treatment for the patient and higher medical expenditures.

Clearly being more competent as a physician and practicing economical, evidence-based medicine is the name of the game. However, I do take offense to this article. It implies that we need a medical alert system to help us perform the correct procedure. This article is comparing apples to oranges based on the example given in Nerenberg’s article.  It is an exaggeration of use of medical alert systems in aiding physicians to be better doctors, while controlling medical costs. First, most EMR’s do have various medical alerts in place already such as denoting allergic reactions of patients to various medications. Even more are on the horizon. This is very helpful to physicians. However, it does not take the place of thinking for us. And definitely, there will never be a system to replace diagnosing and treating patients. Also, Kaiser is not the only health care system with this technology.

Finally, the use of D-dimers is additive, but not the main way a physician diagnosis a blood clot. Radiological testing is most diagnostic. Therefore, the medical alert for D-dimers can change behavior of those physicians ordering the test by having him think twice prior to ordering the test. However, I would like to note that any physician ordering a D-dimer test, and using it solely to diagnose a blood clot in a patient, is a poor diagnostician. A physician of this caliber is bound to have other issues and in my opinion is not a good physician. Bravo for medical alerts! They are helpful to improving patient care, and may help prevent over-ordering of various labs by physicians, but the technology is not able to direct us to performing the correct procedure. That takes training the old fashion way.