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Something isn’t right when you’re considering lawsuit potential when making patient care decisions. I stand by my argument that a GP prescribing an anticoagula

Something isn’t right when you’re considering lawsuit potential when making patient care decisions. I stand by my argument that a GP prescribing an anticoagulant based solely on an iWatch having detected a-fib is grossly negligent (just as—in keeping with my earlier comparison—he would be if he prescribed an anti-hypertensive to a patient who stated they had a BP of 180/120 at home one time). I’m not entirely sure why you docsplained that 12-leads cannot bend spacetime and that a Holter monitor would be likely be ordered to detect intermittent arrhythmias over a longer period of time, but thanks. Can I claim CE hours for this?

citrablue 8y ago
The argument against more monitoring is one of false positives. Suppose the Apple Watch has a 5% false positive rate, and detects problems with 1% of 100 million users.* That's 50k extra patients going to their doctors, thinking there might be something wrong with them. The next test may have a 1% false positive rate. That would put 500 extra patients on anti-coagulants. That may not materially change the public health calculation, or it may. But that's the calculus -- not that a GP would blindly prescribe, just that increasing the top of the funnel is not necessarily a good thing. (Plus, extra cost.) Positives and negative impact of additional testing must be measured for optimal decisions. * numbers to make the math easy
- dan000892 8y ago
  As opposed to the “but I might get sued” argument, I find this argument totally reasonable. Thank you for stating it so clearly. I’m cautiously optimistic but recognize that we need more data because evidence-based medicine is all about testing hypotheses. The hypothesis here is that continuous 1-lead monitoring will provide a net benefit to the population employing it. Maybe it will and maybe it won’t; Either way I think it’s pretty cool that we’re about to amass a ton of relevant data from which we’ll be able to derive an answer.

citrablue 8y ago

The argument against more monitoring is one of false positives. Suppose the Apple Watch has a 5% false positive rate, and detects problems with 1% of 100 million users.* That's 50k extra patients going to their doctors, thinking there might be something wrong with them. The next test may have a 1% false positive rate. That would put 500 extra patients on anti-coagulants. That may not materially change the public health calculation, or it may. But that's the calculus -- not that a GP would blindly prescribe, just that increasing the top of the funnel is not necessarily a good thing. (Plus, extra cost.) Positives and negative impact of additional testing must be measured for optimal decisions. * numbers to make the math easy

dan000892 8y ago
As opposed to the “but I might get sued” argument, I find this argument totally reasonable. Thank you for stating it so clearly. I’m cautiously optimistic but recognize that we need more data because evidence-based medicine is all about testing hypotheses. The hypothesis here is that continuous 1-lead monitoring will provide a net benefit to the population employing it. Maybe it will and maybe it won’t; Either way I think it’s pretty cool that we’re about to amass a ton of relevant data from which we’ll be able to derive an answer.