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Experience As The Standard Of Care

Well versed in using social media to crowd-source opinions on restaurants and stores, this doctor wondered why there wasn't a digital platform to crowd-source health care providers' opinions on treatment options.

By Andrew Brandeis, N.D.

After numerous failures to treat chronic Lyme disease in numerous patients, I turned to my colleagues for insight.  The standard of care recommends Doxycycline 100mg twice per day for 2 weeks, but it just wasn’t enough. Between patients, I texted with a colleague and learned that he was successfully using Doxy at double the dose, coupled with 500mg of Azithromycin and an herb called Samento. I hadn’t heard of that before and hadn’t seen any literature on it, but I trusted him and was willing to try this with a desperate patient. Within a week, my patient’s symptoms began to subside, and I’ve been using that combo for chronic Lyme disease ever since.
It was that doctor’s experience, not his knowledge, that got him better outcomes with Lyme disease. Experience, not knowledge, is the biggest limiting factor between good primary care providers and great ones. In my opinion, providers who refine their experience practicing over time have the highest success rates.  

It’s impossible for doctors to know everything and yet primary care arguably may demand the greatest breadth of knowledge among all the medical specialties. Curious clinicians rely on reference tools like EPocrates to guide our decisions. But surely all doctors who’ve used EPocrates have felt what I’ve felt – a need for a digital reference that would allow us to search other doctors’ experiences rather than other knowledge available in printed literature. Though tools like Yelp help us gain social proof of the value of goods and services we consume in our personal lives, I wished there were similar platforms for health care providers to exchange opinions on the value of decisions they make at work.
Doctors have access to the same tools, but where do we turn when we want social proof that a treatment choice is the right one? I call, text or email my network of mentors. I post on Facebook and in Yahoo groups.  But ask 15 primary care doctors the same question and you'll get 15 different answers. Worse still, the experience that’s captured in these forums is unstructured, not usable at the point of care, and ultimately lost. It’s impossible to do a quick search in a forum to find out how to treat the patient who is in front of you. So good doctors wind up making bad decisions because we have no way to share our experience. 
Medicine's roots are in anecdotes. For thousands of years we've been using clinical observation to drive clinical outcomes. We need a way to combine the methods of the past with the technology of the present to advance the future standard of care.
I practice in a tech-savvy clinic in San Francisco. Thirty percent of my patients write code for Silicon Valley. Whenever I voice my frustration about the lack of tools I need for my practice, it’s always met by a look of why don’t you just build it yourself? on their faces. That’s why along with colleagues at my clinic and the help of some brilliant patients, I decided to create a free smartphone app for doctors to share their experiences with particular clinical decisions they had made. It was amazing to see how motivated my patients were to give their doctor access to better information.
On SharePractice doctors search for any diagnosis, then rank and comment on all the available treatments. Don't like Cipro for a UTI? Vote it down. Prefer cranberry and probiotics? Add it to the list (along with dose, frequency and duration) and tell your colleagues why. 
I love to see popular treatments changing over time. For example, the highest rated treatment for anxiety is currently Valerian (15-45 gtts PO bid-qid prn). This trumps alprazolam and lorazepam. For UTI, the conventional treatment Cipro has been surpassed by Nitrofurantion (100mg PO bid for 5 days).
The way to capture our clinical experience in a reference tool is to participate and build our own. Have an opinion? Share your best practices in SharePractice and create your own standard of care. 
Andrew Brandeis, N.D., is a naturopathic doctor, health care technology consultant, and co-founder of the integrative medical reference SharePractice. Dr. Brandeis earned his doctoral degree from Bastyr University in 2008. He currently practices at San Francisco’s Care Practice. SharePractice is a free app for health care providers and does not generate revenue for its founders.

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Posted by Sonya Collins on Jan 28, 2014 10:40 AM America/New_York
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