Physician diagnostic overconfidence may be harming patients, according to a new study published in JAMA. The study was actually about overconfidence regarding internists’ diagnoses. Even in difficult-to-diagnose cases, where the internists were correct in their diagnosis only 5.8 percent of the time, their confidence in their diagnosis was high. In easier cases, they were right only 55 percent of the time. For the study, that made the physician diagnoses wrong half the time.

As Cheryl Clark reports in a story for Health Leaders Media, one of the authors of the study makes the point that hospitals could do a better job of providing feedback to physicians whose initial diagnosis is wrong. Hardeep Singh, MD, principal author of the study, told Clark that the opportunity for learning is sometimes lost when feedback does not occur.

Singh suggests there is a serious problem regarding diagnostic accuracy:

The whole medical enterprise is based on the fact that one goes to a doctor in the belief that doctors usually know what they’re doing, otherwise you won’t go. If a doctor said, ‘you know, I’m kind of wrong half the time,’ no one is going to come to them.

Patient Engagement Needed

As we’ve previously written, patients and their families need to be engaged and consult reliable online resources and/or seek second opinions.

Since our post on 8/1/13, the Physician Payment Sunshine Act has received little attention, despite the recent start of record-keeping requirements for drug, medical device and certain other healthcare companies that make payments to physicians, and upcoming public reporting of such payments. However, The Wall Street Journal ran a story yesterday, “Doctors Face New Scrutiny Over Gifts.” The Journal reported that some physicians are already reconsidering what gifts, free dinners and other reportable compensation they receive from covered companies:

“John Mandrola, a cardiologist in Louisville, Ky., said he has been paid a total of $1,500 to $2,000 this year by medical-device makers for speaking engagements. Knowing that such transactions will become public has caused him to be more cautious about what fees to accept, he said. He avoids industry reps visiting his office, believing he can get information on new drugs elsewhere. I’ll continue to weigh the benefits and the negatives, and I think the Sunshine Act and the public reporting of all this stuff makes us think about that,” said Dr. Mandrola. “And I think that’s a good thing.”

CMS Advising Physicians to Keep Records

The story reported that the Centers for Medicare and Medicaid Management are advising physicians to keep records of all payments and transfers of value from industry.

Reporting to the Public Begins in September, 2014

Healthcare PR professionals can expect to see increased media coverage of this issue, especially when the data begins to be available on a government website beginning in September 2014. That’s a year away, but the reporting has already begun.

If you’re a healthcare PR or marketing professional, please note: Over-diagnosis and overtreatment resulting from cancer screenings has led an expert panel to suggest that the word “cancer” should not be applied to conditions that are not lethal. The U.S. National Cancer Institute commissioned a panel to study the problem created by too many growths found through screening that are clinically insignificant and indolent in nature. Writing in The Journal of the American Medical Association, the panel reported:

“Screening always results in identifying more indolent disease. Although no physician has the intention to overtreat or overdiagnose cancer, screening and patient awareness have increased the chance of identifying a spectrum of cancers, some of which are not life threatening. Policies that prevent or reduce the chance of overdiagnosis and avoid overtreatment are needed, while maintaining those gains by which early detection is a major contributor to decreasing mortality and locally advanced disease.”

The authors note that while mortality from certain cancers – e.g., breast and prostate – declined between 1975 and 2010, the incidence has increased significantly because the screenings found large numbers of insignificant cancers. In contrast, they note, screening for colon and cervical cancer decreased incidence as well as late-stage disease through detection and removal of precursor lesions.

The panel’s advice? Reclassify  non-lethal lesions as “IDLE” – indolent lesions of epithelial origin. What’s the implication for healthcare PR and marketing professionals? Use caution when promoting screening programs or technologies. Be aware that overtreatment and over diagnosis is a significant problem, and communications about screening or screening technology should reflect this. For example, testing for PSA (prostate specific antigen) should include “informed consent” between patient and doctor, in which the pros and cons of PSA testing are discussed. Healthcare PR professionals should consider including some cautionary statement in their promotions for screening programs and screening technologies. Cancer screening has saved many lives, but patients should be aware of the risks.

With the rise of patient engagement, candor and full disclosure are the new standard.

Data collection begins today for the Physician Payment Sunshine Act (Sunshine Act). Part of Obamacare, the Sunshine Act requires that manufacturers of pharmaceuticals, medical supplies and biologicals report payments they make to physicians and teaching hospitals. This is designed to bring transparency to these financial transactions, most of which are for legitimate purposes.

Some of these payments have raised concerns that prescribing physicians may not be impartial in what they choose to prescribe for their patients. With the Sunshine Act, these payments will now be in the light of day and it is hoped that this will encourage appropriate payment practices and improve confidence in the impartiality of prescribing physicians.

What Are the Implications for Healthcare PR?

What are the implications for healthcare PR? Healthcare PR professionals who work for companies covered by the act or who have such companies as clients should make preparations to handle inquiries that might arise from the media, including bloggers. An audit should be done of payments reported under the act, and potentially controversial payments identified. A plan should be thought through and put in place to handle any media inquiries. This plan would identify spokespersons, have basic answers drafted, and include specific steps for handling inquiries. If needed, spokespersons should receive media training. Key messaging should be prepared that connects back to the company’s core values and product development strategy.

For more information on the Sunshine Act, go to CMS.gov. The program is administered by The Centers for Medicare and Medicaid in the Department of Health and Human Services.