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World Health Care Blog has a post about A Chicken vs. Egg Issue in Medicine

A report yesterday indicated that there is a strange chicken or egg question about how at least one medical diagnosis is made. The issue is: Does the diagnosis precede the choice of treatment, or does the choice of treatment come first, then cause the diagnosis in order to justify the treatment?

It has long been known that physicians are idiosyncratic in their approach to diagnosing patients. In some cases, they prescribe a treatment in the hopes that it will show what the diagnosis was by either working or not working. The character “House” in that eponymous TV show is fond of this approach. And it makes sense when the risks and side effects of the treatment are minimal, and no other approach to diagnosis has worked….

He goes on to discuss how that can affect cycles in medication use as they work or don’t work for treating the symptoms.

As patients, we non-physicians may expect, and even prefer that diagnoses come first, and are based on something other than the need to justify a presumption or guess about the diagnosis. The fact that diagnoses of depression decreased so markedly, so fast, after increasing so dramatically before the FDA warning, at least suggests that diagnoses were being made on less than model criteria and using a variety of processes that may not fit “evidence-based medicine”.

Meanwhile Health as Human Capital has a post about Medical service coding and billing: a complicated system in need of nosy consumers.

Corporations often use health claims data to describe and understand the important health issues faced by their workforce. But medical services coding and billing have a business purpose: how doctors and hospitals get paid. We also recognize that claims data are powerful indicators of how reimbursement policies affect consumer and provider behavior. Depending on who pays, and what is paid for, the behavior of both consumers and providers changes, regardless of the actual health issues being treated.

The Wall Street Journal’s Health Blog posts Treat the Patient–Not the Computer

Sure, there are lots of efficiencies offered by computerized medical records. But the computer can also present an unwelcome barrier between doctor and patient, Michael Hochman, a medical resident in Boston, writes in this morning’s Globe.

Which has a comment that begins:

I think this article is representative of a major misconception about modern EMR’s. Not all EMR’s require typing in order to enter discrete data. One that I am familiar with can take points and clicks and turn them into common english sentences. The other issue that the industry struggles with is the following….