Doctors, like other experts, have limited domain knowledge. The average primary care visit is only 11 minutes, a figure which hasn’t changed since the 1930s, with four minutes of that being the patient talking. Doctors often lack the time to evaluate up-to-date research relevant to specific patients or diseases. In a widely cited and approved study, one researcher, John P. A. Ioannidis, even argued that up to 80% of medical research findings doctors rely on are flawed.
Many doctors and medical professionals lack a basic understanding of statistics. For instance, in one study, sixteen out of twenty HIV counselors said that there was no such thing as a false positive HIV test (Gigerenzer et al 1998). Another study found that British general practitioners rarely change their prescribing patterns, and when they do, it’s not in response to evidence (Armstrong et al 1996). Gigerenzer and others have shown that statistical illiteracy is ubiquitous among patients and doctors. Many confuse sensitivity and specificity, and most physicians do not understand how to compute the positive predictive value of a test. This can cause them to overestimate the probability of someone having a disease, say breast cancer, by an order of magnitude or more.
For someone with a persistent medical problem, going to their usual doctor may not be enough. They need to know more than their physician can tell them, and they need to know it soon. That is the idea behind the new company MetaMed, a personalized medical research service backed by Peter Thiel and Jaan Tallinn. In an interview with VentureBeat, CEO Michael Vassar aims to improve the U.S. medical system by demonstrating a “product that works better than the system.” By using doctors and researchers who understand statistics and how to evaluate the relative importance of research findings, MetaMed provides a diagnosis, treatment recommendations, and referrals to doctors in their network who can provide the treatments best for a specific patient. MetaMed provides “evidence based medicine” rather than vague suggestions solely based on domain-general knowledge.
MetaMed is not cheap — $200/hr — but for those who deeply need a solution and aren’t confident that their doctor is providing it, it may be the best option. For some problems, our health care system doesn’t cut it. 1 out of 3 patients are actually harmed during their hospital stay, and 7% are harmed permanently or even die as a result of medical errors. Autopsies have proven that doctors misdiagnose fatal illnesses as much as 20% of the time. Given all this uncertainty and error, it’s clear that there’s a market for personalized medical advice based on serious research and statistical understanding.
Holding back the implementation of ideal medical treatments is a lack of knowledge. More than half a million medical articles are published annually. It’s impossible to keep up to date on everything. One woman, Deepa Kulkarni, had the tip of her pinky amputated when a door closed on it. Doctors said there was nothing she could do. Instead of giving up, she persisted and was able to find a regenerative medicine therapy that completely grew back her pinky, fingernail and all! This makes one wonder, how many other serious diseases are going uncured and untreated because doctors are not up on the latest research and therapies?
Here are some unfortunate statistics on error in medical care:
- More than half of all patients do not get the recommended care for their condition.
- As many as 98,000 people die in hospitals each year as a result of medical errors that could have been prevented.
- The number of missed major diagnoses has not changed over the past 20-30 years.
- Mis-diagnosis is the leading cause of medical error in outpatient facilities.
- 40 million patients experience delayed or poor care as a result of missing information, including historical, examinations, tests, and medication reports.
- There were up to 1.2 million error-induced preventable deaths between 1996 and 2006.
- In the U.S., medical errors are estimated to result in more than one million injuries per year.
The basic package MetaMed offers starts at $5,000, and provides personalized research in seven key areas: the diagnosis, meaning of test results, risks, prognosis, genetic factors, a literature review, and an overview of treatment options. After research is complete, it is presented in a detailed report. The report delves into much deeper detail than we get from the usual, which is a couple minutes of information from a doctor combined with ad hoc internet searching. The linked sample report shows the level of detail to expect.
If you or someone you know has a medical problem you want to get figured out for good, and you can afford the price, you should consider contacting MetaMed. A lot of money is spent on health care in the USA, and much of it goes to waste. Though $5,000 might seem like a lot, there are many diseases where the opportunity cost of a misdiagnosis or poor treatment greatly exceeds that number. For these cases, making use of MetaMed may be a good choice.
I am curious why no one has ever tried to evaluate individual doctor’s performance. There may be warranted fear of malpractice lawsuits, costs associated with evaluating the evidence (hiring scientists and survey researchers), and the pain of finding out objectively that one’s treatments are not as effective as the medical literature says they are — implying one is not a good doctor.
The doctors I have talked to so far are not keen on the idea and I think it has everything to do with social status and probably real fear of lawsuits.