Giving Doctors the Cyber Treatment
Going to the doctor might soon mean getting a second opinion, on the spot, from the Internet.
Faced with burgeoning new research and dwindling time to spend with each patient, doctors must learn to use computers to answer medical questions quickly, scan the latest studies, find out about new drug therapies and retrieve other information, often before the patient leaves the exam room, UC Irvine College of Medicine officials say.
To teach its students how to do that, the school has won a $50,000 grant to develop a pilot program in “informatics”--integrating information research into the practice of medicine.
In a field that is increasingly complicated and in which new information is voluminous, computers can help doctors research the best ways to treat patients with certain conditions, said Dr. Michael Prislin, director of the research division of the office of medical education. “You can’t carry everything around in your head.”
The standard practice now, he said, is to refer to textbooks and medical journals for information on complicated cases, which is time-consuming. “And you have to ask: Is it the most current information?” he said.
Learning to surf the Net and search medical databases has been part of the curriculum for years at UCI’s medical school and elsewhere, officials say. The grant from the National Board of Medical Examiners--the group that tests all medical school graduates before they can apply for licenses as doctors--will allow UCI educators to design a computer system to measure how well students are seeking data and applying the information to specific patient situations.
Computers are not unfamiliar to physicians, Prislin said. For more than a decade, the business managers of doctors’ practices have used computers for billing, and many physicians store patient information electronically. Computers also are used widely in research to record and analyze data.
“Where they have not been used a lot is in the day-to-day clinical setting,” Prislin said.
Consulting the latest research online is not necessary for the bulk of patient cases in a family medicine practice, he said.
“For a patient with a sore throat, I’m probably not going to refer to the literature,” Prislin said. “But it’s that situation where there is a technically complex problem and I need more information. Or it’s a case of something I don’t see all that often, or where there may be a set of conflicting options for treatment. You want to be able to give the patient the best information.”
For example, he said, there are three ways to treat a patient with coronary heart disease: medication, bypass surgery and angioplasty. By perusing the latest literature, the physician can find out which procedure has worked best with different types of patients, then report the findings to the patient waiting in the examining room, Prislin said.
There are a number of medical databases for physicians to consult. Prislin said the National Library of Medicine operates Medline, which can tap into Pub Med, an online service for published medical studies. Several medical schools also have similar services.
At UCI’s medical school, students are introduced to medical informatics through their interactions with “standardized patients,” actors who portray patients with certain ailments and conditions. In “patient-doctor” courses, a group of students is assigned to a case involving, for example, cancer or cardiac disease, Prislin said. After interviewing the standardized patient, the students develop lists of questions posed by the case. They must find the answers by searching the medical databases online, the professor said.
Common scenarios might include a patient complaining of chest pain, a 5-year-old with a recurrent bacterial ear infection or a man with suspected lung cancer. The problems to be addressed could include drug interactions or resistance to antibiotics.
How the students frame the questions can determine what information they retrieve, he said. If they are dealing with a menopausal patient who possibly needs estrogen replacement and is at risk for osteoporosis, for example, the students risk tapping into “millions of papers” if they do not narrow their search properly, he said.
The grant will allow the medical school to develop a computer program that will assess the quality of the students’ online searches, Prislin said.
A second part of the project will measure how well the students apply the computer-generated information to the standardized patients, he said, and will compare the performance of students who use computers with those who do not.
The ability to research medical questions quickly is especially important in the age of managed care, which can restrict the amount of time physicians spend with patients, medical school officials said. Studies show that physicians now pursue only 30% of the questions that arise during patient visits, they said.
Computers will never replace doctors’ experience, Prislin said. But when physicians need to supplement their base of knowledge, they should be computer-savvy.
“Clearly, there is a need to have accurate information readily available,” Prislin said. “With this award, we’re in the process of measuring how well we’re preparing the practitioners of the 21st century.”
