I’m overall not impressed- looking at their reports, what do they offer that up-to-date (uptodate.com) doesn’t? Sure, they advertise at patients, and up to date is aimed at institutions- but most hospitals I’m familiar with (and hence almost any specialist physician) are going to have access already to up-to-date. Also, in general, I’m willing to bet most doctors are in a better position to digest a research report than the average patient.
Sure, its a good idea, but its already being done in a very comprehensive fashion by a company that already has something like 90+% market penetration for academic hospitals. What is metamed’s comparative advantage?
That seems a very tricky proposition- for $5k you get a team of medical students and phd students doing a literature search for 24 hours. Without a diagnosis to start with and without an ability to order and receive test results (even if you suggest a test, will the results be back in 24 hours?) my prior would be that diagnosis would be extremely unlikely. WIthout a diagnosis, I’m not even sure how informative such a short literature search can be.
In the case of symptoms-just-started/no diagnosis, doesn’t an experienced doctor at a hospital (with all the support staff a hospital implies-. labs,etc) have a pretty high competitive advantage? Apriori, an experienced physician with diagnostic equipment and several days should outperform some medical students with journal access and 24 hours.
Also, this whole thread I find myself shilling for the status-quo, but I should make it clear- hospitals scare the hell out of me. I’ve done statistical work for internal performance reviews for a large carrier in Southern California and found tons of alarming medical mistakes. I just don’t see how Metamed solves any of the actual problems. Most mistakes are of the form transfer orders go through, but patient isn’t moved (thus being on a floor under no one’s care for X hours), or pharmacy doesn’t deliver a necessary medication to a patient in a timely fashion, pharmacy compounded medication in the wrong fluid, ICU doctor refuses to admit ICU level patient because he wants to go home early (leaving a critical patient in a DOU). Total misdiagnosis/mismanagement DOES happen,but its not a leading-order type of mistake, and its usually not because of a lack of access to relevant evidence-based-medication, but rather despite a lot of access to info. Also, at least at one large hospital group in Southern California- this mistreatment tends to be Bayesian in nature- most patients are things like heart attack/stroke and so if you present with symptoms that fit even loosely into one of those large categories, you get treated for them. Such a system does a lot of good for the typical patient ,but if you have a rare disease, it can send you totally down the wrong path. Trying to ‘fix’ this problem can do more harm than good (save the occasional rare illness patient at the expense of dozens of more typical patients)
The best solution is to find a competent doctor (or even a competent ICU nurse) and pay them to be the point of contact all the hospital doctors have to go through before they are allowed to treat you, but hardly anyone can afford a concierge doctor.
This matches my feeling that a lot of what’s wrong with (American?) medicine is the result of patients being viewed as low status.
What you’ve been seeing is what can go wrong at the hospital. I’ve heard a fair amount of anecdotes about sloppy diagnosis—patients’ symptoms being ignored for months or years of doctor visits. My impression is that doctors who listen and think are not terribly common.
A typical family doctor’s appointment is scheduled every 15 min where I am (except for annual checkups). This includes the time between patients for any necessary paperwork. So, not much you can do for people with rare symptoms in that setting. This is where MetaMed can help, since they spend 100 to 1000 times more time than that on each case and are looking specifically for edge cases and individualized treatment.
I agree that fifteen minutes minus paperwork is shockingly short. Still, there are doctors who do reasonably well at paying attention.
Most of my information is from the fat acceptance community, where there are a great many stories about doctors who just tell fat patients to lose weight*, regardless of symptoms. The typical stories seem to be either “I had to go to three or four doctors to find one who would listen” or “I must be lucky, I have a great doctor”. I can’t derive a strong opinion about the proportion of attentive doctors from this, though I wouldn’t be surprised to find that it’s under half.
*I’ve also seen a few stories from unusually thin people who were simply told to gain weight, and one from a man who (as far as I could tell) was lean and muscular, but was told to lose weight by a doctor who literally only looked at his BMI.
A fat friendly professional does not necessarily avoid mentioning a client’s weight, but he or she avoids making an issue of it, avoids lectures and humiliation, and respects the client’s wishes with regard to weight discussions.
If a client asks not to be weighed, the request is acknowledged without complaint and taken into account automatically on future visits. (Note: there are a few cases where weighing is necessary, for example, when administering certain medications, chemotherapy, or anesthesia.)
If weight sometimes contributes to a problem, the professional may mention this, but also considers other diagnoses and recommends tests to determine the actual diagnosis if appropriate. If weight loss is a recommended treatment for a problem, the fat friendly professional may mention this, but at minimum will also recommend and prescribe other treatments. A fat friendly professional accepts a client’s wish not to use weight loss as a treatment.
Ideally, the professional’s office has available armless chairs, large blood pressure cuffs, large examination gowns, and other equipment suitable for fat people. If not, the office acknowledges the importance of such items when told.
Some fat friendly professionals believe that fat is not unhealthy. Others may believe that fat is unhealthy, but may acknowledge that weight loss doesn’t work or is dangerous and/or that the client has a right to direct his or her own treatment.
Sure- but if you have some rare symptom, any decent family doctor should say “go see a specialist” and refer you. You certainly aren’t going to contact metamed every time you get sick, and for chronic conditions, a specialist (with journal and up-to-date access) is going to be the managing physician. Anything other than routine sniffles, vaccinations and check-ups and you probably have exceeded your family doctor’s expertise.
The big problem for misdiagnosis at the family-med level are the hordes of relatively rare diseases with common symptoms, but this is a very hard problem to solve. Having spent some time dealing with this as a statistical problem, even if you have a rare cluster of common symptoms, its usually the case that you are more likely to have a rare presentation of a common disease than it is that you have a rare disease.
Presumably what you’re paying for is for someone smarter than you to do the literature research for you; if I’m reading uptodate’s product page correctly, they make the information available but it’s up to you (or your physician) to sort through it and figure out what applies to you.
UpToDate provides a summary of research based on disease. i.e. for this disease, these treatments are recommended because of study A,B and C and physiological facts D, E and F. There are counter-indications and risks from these treatments because of x,y, and z. Unfortunately, I can’t reproduce one of their reports here, but its not just a huge literature dump, its summarized and treatment options are graded.
Looking at the metamed concierge report on Gout (linked to elsewhere in this thread) its formatting appears to be very much like an UpToDate report- the most recent literature is digested and summarized at a decently high level, but it doesn’t strike me as better than (or even different from!) the UpToDate recommendations. Given that 90% of academic hospitals already have paid for UpToDate, and honestly in most cases it will be better for the physician to interpret the report, I can’t see very much for metamed to bring to the table.
Also worth pointing out- the people who write the summaries for UpToDate are most often researchers in the field of the illness. Near as I can tell from their webpage metamed’s researchers are often medical students, or non-medical phd students (the point being that with metamed you are paying for something general called “expertise” and in many cases not actual field-relevant medical expertise).
What’s the price difference between metamed and going out of your way to go to an academic hospitals? Am I wrong in thinking most hospitals are not academic hospitals?
Probably depends on your insurance (i.e. if you are with an HMO, you’ll be locked in to the network unless you get a referral). Outside of HMOs, I’m not aware of an insurance that has a copay difference between going to an academic or community hospital. If you go to a community hospital with something complicated, you’ll almost certainly end up transferred to an academic referral center anyway.
I’m overall not impressed- looking at their reports, what do they offer that up-to-date (uptodate.com) doesn’t? Sure, they advertise at patients, and up to date is aimed at institutions- but most hospitals I’m familiar with (and hence almost any specialist physician) are going to have access already to up-to-date. Also, in general, I’m willing to bet most doctors are in a better position to digest a research report than the average patient.
Sure, its a good idea, but its already being done in a very comprehensive fashion by a company that already has something like 90+% market penetration for academic hospitals. What is metamed’s comparative advantage?
I get the impression that Metamed also figures out likely diagnoses, which would be a pre-requisite for using Up to Date.
That seems a very tricky proposition- for $5k you get a team of medical students and phd students doing a literature search for 24 hours. Without a diagnosis to start with and without an ability to order and receive test results (even if you suggest a test, will the results be back in 24 hours?) my prior would be that diagnosis would be extremely unlikely. WIthout a diagnosis, I’m not even sure how informative such a short literature search can be.
In the case of symptoms-just-started/no diagnosis, doesn’t an experienced doctor at a hospital (with all the support staff a hospital implies-. labs,etc) have a pretty high competitive advantage? Apriori, an experienced physician with diagnostic equipment and several days should outperform some medical students with journal access and 24 hours.
Also, this whole thread I find myself shilling for the status-quo, but I should make it clear- hospitals scare the hell out of me. I’ve done statistical work for internal performance reviews for a large carrier in Southern California and found tons of alarming medical mistakes. I just don’t see how Metamed solves any of the actual problems. Most mistakes are of the form transfer orders go through, but patient isn’t moved (thus being on a floor under no one’s care for X hours), or pharmacy doesn’t deliver a necessary medication to a patient in a timely fashion, pharmacy compounded medication in the wrong fluid, ICU doctor refuses to admit ICU level patient because he wants to go home early (leaving a critical patient in a DOU). Total misdiagnosis/mismanagement DOES happen,but its not a leading-order type of mistake, and its usually not because of a lack of access to relevant evidence-based-medication, but rather despite a lot of access to info. Also, at least at one large hospital group in Southern California- this mistreatment tends to be Bayesian in nature- most patients are things like heart attack/stroke and so if you present with symptoms that fit even loosely into one of those large categories, you get treated for them. Such a system does a lot of good for the typical patient ,but if you have a rare disease, it can send you totally down the wrong path. Trying to ‘fix’ this problem can do more harm than good (save the occasional rare illness patient at the expense of dozens of more typical patients)
The best solution is to find a competent doctor (or even a competent ICU nurse) and pay them to be the point of contact all the hospital doctors have to go through before they are allowed to treat you, but hardly anyone can afford a concierge doctor.
This matches my feeling that a lot of what’s wrong with (American?) medicine is the result of patients being viewed as low status.
What you’ve been seeing is what can go wrong at the hospital. I’ve heard a fair amount of anecdotes about sloppy diagnosis—patients’ symptoms being ignored for months or years of doctor visits. My impression is that doctors who listen and think are not terribly common.
A typical family doctor’s appointment is scheduled every 15 min where I am (except for annual checkups). This includes the time between patients for any necessary paperwork. So, not much you can do for people with rare symptoms in that setting. This is where MetaMed can help, since they spend 100 to 1000 times more time than that on each case and are looking specifically for edge cases and individualized treatment.
I agree that fifteen minutes minus paperwork is shockingly short. Still, there are doctors who do reasonably well at paying attention.
Most of my information is from the fat acceptance community, where there are a great many stories about doctors who just tell fat patients to lose weight*, regardless of symptoms. The typical stories seem to be either “I had to go to three or four doctors to find one who would listen” or “I must be lucky, I have a great doctor”. I can’t derive a strong opinion about the proportion of attentive doctors from this, though I wouldn’t be surprised to find that it’s under half.
*I’ve also seen a few stories from unusually thin people who were simply told to gain weight, and one from a man who (as far as I could tell) was lean and muscular, but was told to lose weight by a doctor who literally only looked at his BMI.
International list of fat-friendly medical professionals
Sure- but if you have some rare symptom, any decent family doctor should say “go see a specialist” and refer you. You certainly aren’t going to contact metamed every time you get sick, and for chronic conditions, a specialist (with journal and up-to-date access) is going to be the managing physician. Anything other than routine sniffles, vaccinations and check-ups and you probably have exceeded your family doctor’s expertise.
The big problem for misdiagnosis at the family-med level are the hordes of relatively rare diseases with common symptoms, but this is a very hard problem to solve. Having spent some time dealing with this as a statistical problem, even if you have a rare cluster of common symptoms, its usually the case that you are more likely to have a rare presentation of a common disease than it is that you have a rare disease.
I think MetaMed is intended to supplement the treatment advice you’d otherwise receive from specialists.
Presumably what you’re paying for is for someone smarter than you to do the literature research for you; if I’m reading uptodate’s product page correctly, they make the information available but it’s up to you (or your physician) to sort through it and figure out what applies to you.
UpToDate provides a summary of research based on disease. i.e. for this disease, these treatments are recommended because of study A,B and C and physiological facts D, E and F. There are counter-indications and risks from these treatments because of x,y, and z. Unfortunately, I can’t reproduce one of their reports here, but its not just a huge literature dump, its summarized and treatment options are graded.
Looking at the metamed concierge report on Gout (linked to elsewhere in this thread) its formatting appears to be very much like an UpToDate report- the most recent literature is digested and summarized at a decently high level, but it doesn’t strike me as better than (or even different from!) the UpToDate recommendations. Given that 90% of academic hospitals already have paid for UpToDate, and honestly in most cases it will be better for the physician to interpret the report, I can’t see very much for metamed to bring to the table.
Also worth pointing out- the people who write the summaries for UpToDate are most often researchers in the field of the illness. Near as I can tell from their webpage metamed’s researchers are often medical students, or non-medical phd students (the point being that with metamed you are paying for something general called “expertise” and in many cases not actual field-relevant medical expertise).
What’s the price difference between metamed and going out of your way to go to an academic hospitals? Am I wrong in thinking most hospitals are not academic hospitals?
Probably depends on your insurance (i.e. if you are with an HMO, you’ll be locked in to the network unless you get a referral). Outside of HMOs, I’m not aware of an insurance that has a copay difference between going to an academic or community hospital. If you go to a community hospital with something complicated, you’ll almost certainly end up transferred to an academic referral center anyway.