My Dad died because the Cardiologist didn't think to refer to a Neurologist | Hacker News Reader

My Dad died because the Cardiologist didn't think to refer to a Neurologist

13 pointssbssmadhav13 comments

My Dad died because the Cardiologist who was treating him didn't know that he was going to have a stroke even though he complained of all the typical pre-stroke symptoms, i.e. severe headache, high blood pressure, high cholesterol, dizziness. The doctor controlled his blood pressure but, saw nothing alarming in EKG, ECG etc.

Could this have been avoided if the Cardiologist and a Neurologist consulted each other. Hell yeah. Can we solve this with software tech? I think so, I am working on a platform (Web + Mobile) for simpler, better communication between different specialists in medicine (unfortunate, sometimes doctors in the same hospital don't talk to each other, let alone outsiders)

I know HN is a great place with forward thinkers, your thoughts are much appreciated.

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I'm sorry to read about your loss, and I applaud your initiative. I believe a large part of the reason things like this happen is because the solution is so enormously complex. Developing the software tech (a undertaking in itself) is one thing. Also required: updating/changing existing regulations (slow & bureaucratic), training & support, budget approvals, politics, not to mention the doctor's decision-making process and communication responsibilities...the list goes on and on!

Eventually we will have a better system. Unfortunately this is likely to be a very slow, gradual process, which I hope to witness over the course of the next few decades. In this particular case, software tech could have served as a communication platform to reduce the chances of doctor miscommunication and/or overlooking a patient's varying conditions. Generally speaking (and by my personal experience), doctors seem to be notoriously bad about communicating the overall picture to responsible parties, at least here in the U.S. Each doctor takes care of his/her own "backyard" before dashing off to the next patient. I recognize that this is by no means solely the fault of the doctor. It's the system!

Again, good on you for wanting to be part of the solution.

So, your problem isn't simple ease of communication. Your problem is willingness to communicate. You even recognize that, because you say that doctors in the same hospital don't talk to one another.

That's not easily solved with tech. It's solved with hospital policies that foster communication.

I'm sorry for your loss. Unfortunately, the doctor would still have to recognize that a neurologist needs to be brought in, even if communication was facilitated.

I agree, but there is room to think about a tech solution a little further.

What if the patient himself foster the communication? If the patient can input all the symptoms and the results of all the exams ordered by one doctor, the system can detect all the "red flags" that a particular result raises and tell you which kind of specialist should take a look at it. Example: your cardiologist register dizziness and high blood pressure. The system knows that a cardiologist already saw it, but it also alert you that these results and symptoms should be studied by a neurologist and a endocrinologists.

Using the examples of dizziness and high blood pressure, you've got thousands of possible outcomes and stroke is not the most common. This is an incredibly complex system, made more so by the fact that it's so individual. If I experience dizziness and high blood pressure, it potentially means something quite different than if you do.

I'm not saying it isn't worthwhile. It is. But let's say you raise all these symptoms and red flags and decide you need specialized testing from 3 different specialists. Then it turns out you didn't need that testing at all.

Who pays for it? Your insurance company won't.

One of the things I'm working on right now is software to facilitate the coding process for payment and insurance purposes, and let me tell you, it is complex for a reason. The insurance companies do NOT want to pay.

This is changing. One of the most likely potential models is a condition based pay model. An example case would be a 50 year old smoker with high blood pressure; the insurance company says, ok, on average it costs $1000 to cover this person for one year. They pay the hospital $1000. If the patient needs a procedure, the hospital eats the excess cost. If the patient needs no procedure, the insurance company does.

Now, couple this with a change in how MD's are reimbursed, so it's a performance based plan rather than a procedure based plan, and you have a more efficient and better managed system.

We're not quite there yet. When we are, your planned software might work. Give it 1.5-2 years at a minimum. The new coding processes come out in 2014 and we're shifting away from private practice, but it takes time.

indeed, i think the patient (and family) probably cares more about patient's health than the doctors (unfortunately true). my solution is along the lines of what healthtap is doing, the patient posts a question and a few real doctors respond back, the patient makes a better informed decision than rely on a single physician to make or break his/her life!

one big difference between what i am developing versus what healthtap is doing is that i want to develop some sort of scoring for doctors' responses so that we can help the patient make a better decision instead of being confused with 10 or 20 different responses. actually even worse, many doctor responses on healthtap and other such sites is something along the lines of "you should see your doctor", duh!

guess you are right to an extent, doctors may not be the best communicators given the nature of the profession, privacy laws, time etc however, sometimes a nudge could make all the difference, don't you think? a nudge from an "app" to prompt the doctor to think of other possibilities beyond their expertise.

Check out the NHS Direct Symptom Checker http://www.nhsdirect.nhs.uk/checksymptoms

I doubt it has a public API available (although that's certainly something I'd advocate the NHS building), but it might give you an idea of the sheer complexity involved in something like this.

...and people will criticise from both ends. One group of people will say that it's too safe; driving costs up and subjecting people to unneeded tests and hospital visits (which are not risk free). Another group of people will say that it's not safe enough, that it should err on the side of caution, that it is risking people's lives by not sending them to hospital soon enough.

I think it would be nice to have an app to: - allow person to select quickly and easily a set of symptomes that he/she feels. - Upon submission the app would send notification to person's doctor as well as search world's databases for possible diagnosis.

This way your dad would get an immediate feedback on his screen: "POSSIBLE STROKE! URGENTLY CONTACT YOUR DOCTOR", allowing him or his loved one to apply extra pressure to medical professionals.

what you propose is interesting, it's so simple that it sounds borderline idiotic but i think this awareness alone could have prompted my dad to ask his doctor about a possible stroke or approach a neurologist just to be on the safer side.

Can you tell us in more detail about your application?

All those doctors can use IM, phone, email to communicate.

A small group of us are interested in developing healthcare related apps. My email is ryan.teo (at) gmail.com.

Yes, you are right, most doctors can also use their commonsense but in my dad's case they didn't! i hesitate to say this as my best buddy is a neurologist but i agree with vinod khosla, in a few years doctors as we know them today will be replaced by technology (http://venturebeat.com/2012/09/02/vinod-khosla-says-technolo...)!

they should be able to work on a higher level, just as we moved up the chain from punch cards and assembly code on 8080s doctors need to move up the chain as well, otherwise we will have many near and dear ones dying due to single point failure (PCP)!

to answer your question, i am working on an app (will post a link to it in the next 2-3 weeks) that brings the patient closer to more physicians, hopefully someone relevant, in my dad's case, a neurologist (at least it takes the risk of seeing one doctor out of the equation).

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