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INNOVATIONS IN
MEDICAL PRACTICE

DIAGNOSING

AND TREATING

OUR HEALTHCARE SYSTEM

By Darren Donahue, JD, MD Candidate UT Health San Antonio

If the healthcare debate of the past six months is any indication, it individual in-
is that many support comprehensive reform or replacement of the stance can vary in
ACA, while others worry about what that might mean for physicians, severity and con-
patients, and the indigent. Surely this will be the topic of much dis- sequences. In the
cussion at the local, state, and federal levels in the coming years. This case of Dissocia-
is, after all, a subject where reasonable minds can and do differ. In tive Hypermetri-
anticipation of these inevitable differences, I would like to make a cosis, the data
modest proposal for how we in the medical community should ap- collection distracts
proach these conversations no matter whether they include legisla- and burdens the
tors, healthcare providers, family, or friends. I propose that as we physician and
participate in this ongoing debate that we act like doctors. provides no added
benefit to the in-
In diagnosing and treating their patient’s health conditions, physi- dividual patient.
cians assemble a differential diagnosis composed of several conditions In the most severe
which might be causing the patient’s symptoms. The systematic ap- form — Malig-
proach of eliminating possible causes one-by-one before being left nant Dissociative
with the most likely diagnosis ensures that treatment is narrowly tai- Hypermetricosis
lored and specific to the underlying etiology. Shouldn’t the same ap- — inefficient col-
proach be used when addressing the conditions and diseases of the lection and use of
healthcare system that policy makers say they are so eager to cure? poor quality and
inaccurate data
This begs the question of how one might construct a differential can impair the delivery of care and even directly harm individual pa-
diagnosis for a healthcare system. The Patient Institute’s Conditions tients. For example, some electronic medical record systems warn
and Diseases of Healthcare Systems (“CDHS”)1 was created to name staff against providing cefazolin — a standard preoperative antibiotic
and describe specific characteristics of the healthcare system, doctors, therapy — to patients who report penicillin allergies despite the fact
and patients that lead to poor outcomes in medical treatment. We that cross-reactivity between penicillin and cephalosporins is very
name these conditions for the same reason that we name diseases in low. As a result, patients are given clindamycin instead which can
medicine: Precisely identifying a condition is a prerequisite to com- and does, in many cases, cause a Clostridium difficile enterocolitis.
municating about it and studying its distribution and pathophysiol- Since the healthcare system is replete with hypermetricoses, curing
ogy. Of course, the end goal is to remediate, cure, and prevent these of this disease would be an excellent target of reform.
conditions from occurring. While still a work in progress, the CDHS
is an excellent resource for constructing such a differential. Or consider Benefit Managementosis where due to the common
structure of healthcare payment and reimbursement, a third or
Take for instance, the spectrum of disease called Hypermetricosis. fourth-party uses the (pre)authorization process to control whether
This condition results from the voluminous and inefficient collection a patient receives a particular test or therapy. Alarmingly, benefit
and use of data that can distract providers from delivering care to in-
dividual patients. As Hypermetricosis is a spectrum of disease, each

22 San Antonio Medicine • September 2017