In a preview to the future – who performs better at predicting outcomes, a physician, or a computer?
Unsurprisingly, it's the computer – and the unfortunate bit is we're not exactly going up against Watson or the hologram doctor from the U.S.S. Voyager here.
This is Jeff Kline, showing off his rather old, not terribly sophisticated "attribute matching" software. This software, created back in 2005-ish, is based off a database he created of acute coronary syndrome and pulmonary embolism patients. He determined a handful of most-predictive variables from this set, and then created a tool that allows physicians to input those specific variables from a newly evaluated patient. The tool then finds the exact matches in the database and spits back a probability estimate based on the historical reference set.
He sells software based on the algorithm and probably would like to see it perform well. Sadly, it only performs "okay". But, it beats physician gestalt, which is probably better ranked as "poor". In their prospective evaluation of 840 cases of acute dyspnea or chest pain of uncertain immediate etiology, physicians (mostly attendings, then residents and midlevels) grossly over-estimated the prevalence of ACS and PE. Physicians had a mean and median pretest estimate for ACS of 17% and 9%, respectively, and the software guessed 4% and 2%. Actual retail price: 2.7%. For PE, physicians were at mean 12% and median 6%, with the software at 6% and 5%. True prevalence: 1.8%.
I don't choose this article to highlight Kline's algorithm, nor the comparison between the two. Mostly, it's a fascinating observational study of how poor physician estimates are – far over-stating risk. Certainly, with this foundation, it's no wonder we're over-testing folks in nearly every situation. The future of medicine involves the next generation of similar decision-support instruments – and we will all benefit.
"Clinician Gestalt Estimate of Pretest Probability for Acute Coronary Syndrome and Pulmonary Embolism in Patients With Chest Pain and Dyspnea."