Day 1 :
Chicago Medical School, USA
Time : 10:15-11:05
Rabi F Sulayman has completed his MD from the American University of Beirut. He completed his Pediatric Residency at Boston Children’s Hospital, Harvard Medical School and Pediatric Cardiology Fellowship at the University of Chicago. He is credited for the Building and Development of the Advocate Children’s Hospital, Oak Lawn campus. He has demonstrated expertise in the development of Advanced Clinical and Educational Programs at the national and international levels, with collaborative programs in many hospitals in East Africa and China. He is currently the Emeritus Chairman at Advocate Children’s Hospital, Oak Lawn and Professor and Chairman at the Chicago Medical School-Rosalind Franklin University.
Background: The digital revolution has infiltrated every aspect of our lives resulting in the medical transformation of how we obtain and provide healthcare. Physicians today have access to computer-based systems designed to provide diagnostic support and prevent mistakes. While it has been shown that these systems can be helpful, their actual impact continues to be a subject of debate.
Objective: To demonstrate the impact of Differential Diagnosis Generators (DDX) and Decision Support Systems (DSS) on the physician’s clinical reasoning, diagnostic capabilities, practice skills and patient outcomes.
Method: Literature review for published evidence and personal interviews with medical students, residents and hospitalists who provide care for most of the hospitalized patients.
Result: The reviewed literature revealed that these systems are a valuable source of information, but none provided a specific diagnosis or prevented diagnostic mistakes. Their impact on care delivery and patient outcomes was marginal and, in some cases, may have impaired clinical judgement and exposed patients to risk. These negative effects on the physicians were recognized. Out interviews revealed that medical students and residents are more likely to utilize these systems than hospitalists. They found them to be helpful in providing information, but not a diagnosis. It was also reported that use of these systems is cumbersome, time consuming and hence not helpful in emergency situations. Two interviewees reported increased confidence, while one reported being misguided.
Conclusion: Available systems do not provide a diagnosis and do not prevent mistakes. They have a negative impact on the physicians’ performance. Such impact requires further evaluation. Attending physicians rely on memory or obtain information from other sources. Clinical reasoning skills continue to be critical and algorithms are not likely to replace the physician.
Recommendation: Critical thinking must be taught in the pre-clinical years and continue to be exercised in the post-graduate years. Replace the systems with a more accurate diagnostic tool capable of providing structured, system-oriented problem solving and pattern recognition. This will most likely be a paper tool (not electronic) available at the bedside to allow instantaneous recognition of patient progress.
Ravi Gutta completed his Internal Medicine residency, MD and Allergy & Immunology Fellowship at Cleveland Clinic, USA. He was proctor for his internal medicine board exams during his residency, chief fellow during his fellowship and graduated in the top ten percent in the country for both his Internal Medicine and Allergy and Immunology board exams. He is American Board Certified in Allergy and Immunology and Internal Medicine.
Food Allergy is a broad category entailing all adverse reactions to food which included IgE mediated true food allergy, oral food pollen syndrome, systemic manifestations of food allergy i.e. cow’s milk protein enterocoloits or proctocolitis, Heiner’s syndrome, food protein induced enterocolitis(FPIES), Atopic dermatitis due to food allergy, Celiac disease and finally food intolerance. It is very important for nutritionists and pediatricians to have thorough understanding of each of these elaboratively about etiopathogenesis, clinical manifestations, natural history, diagnosis, treatment plan. It is important to understand the latest LEAP Study recommendations on demining of introduction of foods to infants. Peanut Allergy is the only allergic condition with 400% increase in incidence and population prevalence is last decade along with increase in other food allergies among general population. A food allergy is when body’s immune system reacts to a food protein, is considered as “food allergen.” The response body has to the food is called an “allergic reaction.” A food allergy diagnosis is life-altering. People can be allergic to any food, but nine foods cause most food allergy reactions in the U.S. They are: milk, egg, peanuts, tree nuts (such as walnuts or pecans), wheat, soy, fish, and shellfish (such as lobster, shrimp or crab), Sesame seed. Unlike a food intolerance, food allergies involve the immune system and can be life-threatening. It is very important for pediatricians and nutritionists to evaluate and identify culprit foods which cause IgE mediated food allergy and completely avoid them in the patient’s diet, educate patient about how to read labels, how to avoid cross contact with allergenic foods, demonstrate to use EpiPen, explain indications for its use storage and shelf life. Finally, it’s very important to explain patient or patient’s parents about anaphylaxis action plan, which entails how to identify various allergic reactions to foods i.e. minor reaction, severe reaction or anaphylactic reaction and treat accordingly based on action plan recommendations.