Trust the doctor or a computer analysis

The papers were filled this morning with a $200 million Medicaid scandal involving patients being given drugs unapproved by the FDA.  (Picture from Under Mouse Arrest.)

The media focus was on the payments, or on patients being duped, or on the FDA's drug review process. But there is a bigger, more important issue in play here.

Trust.

Every patient taking these prescriptions trusted a clinician that what they were getting would help them. Every clinician who wrote these prescriptions trusted they were doing the right thing.

Trust is an important element in healing. Any doctor will tell you that. Prayer and faith are all about trust, and I do not doubt the miracles that can result.

Trust is something we give to other people. We don't readily give it to institutions, or the government, let alone technology.

In doing this we leave ourselves open to being conned. Con men prey on trust. They exist in both religion and medicine. They always have. They also exist in government.

But that's not what seems to have happened in this case. What happened instead is that clinicians continued to trust old information, or chose to ignore new information. And patients trusted their judgement.

This leads directly back to computer technology. It can, at the point of care, deliver clinicians information that may make them question earlier judgements. It can even pro-actively deny reimbursement on obsolete care regimens.

Which then leads back to the question of whether we are placing our trust in technology, or in the people whose knowledge informs the answers technology gives us.

There are no easy answers here, but as we proceed toward revolutionizing health IT, bringing better answers to the point of care, we should probably start asking these harder questions.

Do you want your doctor trusting their gut, or the decisions that come from computer analysis?