From second to hundredth opinion in medicine: A global consultation platform for physicians

Evan D Muse,Job G Godino,Jessa F Netting,Helen J Moran,James F Alexander,Eric J Topol

doi:10.1038/s41746-018-0064-y

Abstract

Serious medical diagnostic errors lead to adverse patient outcomes and increased healthcare costs. The use of virtual online consultation platforms may lead to better-informed physicians and reduce the incidence of diagnostic errors. Our aim was to assess the usage characteristics of an online, physician-to-physician, no-cost, medical consultation platform, Medscape Consult, from November 2015 through October 2017. Physicians creating original content were noted as “presenters” and those following up as “responders”. During the study period, 37,706 physician users generated a combined 117,346 presentations and responses. The physicians had an average age of 56 years and were from 171 countries on every continent. Over 90% of all presentations received responses with the median time to first response of 1.5 h. Overall, computer- and device-based medical consultation has the capacity to rapidly reach a global medical community and may play a role in the reduction of diagnostic errors.

Highlights

Medical diagnostic errors are not infrequent and are a major cause of adverse outcomes in both the inpatient and outpatient setting.[1,2,3] Outpatient diagnostic error rates have been estimated at 5% affecting >12 million individuals per annum, whereas inpatient diagnostic errors range from 6 to 7%.2 when using expert consultants as the ground truth for diagnosis, >20%of referral diagnoses in a recent study were vastly different compared with final diagnoses.[4]
This illustrates the importance of strong physician networks to discuss potential diagnoses and obtain second opinions on specific cases
Factors relating to physician confidence, access to specialists, affordability of care, and availability of health informatics resources have all been recognized as probable barriers preventing a formalized networked approach leading to diagnostic errors.[3,7]

Summary

Introduction

Medical diagnostic errors are not infrequent and are a major cause of adverse outcomes in both the inpatient and outpatient setting.[1,2,3] Outpatient diagnostic error rates have been estimated at 5% affecting >12 million individuals per annum, whereas inpatient diagnostic errors range from 6 to 7%.2 when using expert consultants as the ground truth for diagnosis, >20%of referral diagnoses in a recent study were vastly different compared with final diagnoses.[4]. Medical diagnostic errors are not infrequent and are a major cause of adverse outcomes in both the inpatient and outpatient setting.[1,2,3] Outpatient diagnostic error rates have been estimated at 5% affecting >12 million individuals per annum, whereas inpatient diagnostic errors range from 6 to 7%.2. When using expert consultants as the ground truth for diagnosis, >20%. Informal faceto-face consultations, known more commonly as curbside consultations, are frequently inaccurate and incomplete when compared with formal professional consultations.[5,6] factors relating to physician confidence, access to specialists, affordability of care, and availability of health informatics resources have all been recognized as probable barriers preventing a formalized networked approach leading to diagnostic errors.[3,7]

Objectives

Results

Conclusion