Readings and Listening To Consider - 10/10/24

Books and Articles Worth a Review… 

Towards Sensitive or Get Specific – Marc Ringel, MD – one of my colleagues in the healthcare arena – recently posted an article in Chicago Life entitled, Sensitive or Specific?  It’s a good piece for all of us the healthcare types who read The Fickenscher Files to read and consider. He points out that the current focus of the USA health care system heads toward sensitivity which rewards the practitioner and the system with more procedures resulting in more money. However, if the system were focused on specific, we’d be right much more often than wrong in our initial impressions. So, the issue for the healthcare community is the balance between sensitive and specific. His example is the diagnosis of diabetes. If we set the diagnostic blood level high enough, it will always be correct in making the diagnosis of “diabetes”. However, if it’s too low, the number of people captured with the diagnosis will be too large since many of them will not have diabetes. Such was the case set by the National Institutes of Health back in 2021 when it set the recommended blood level for a diagnosis at a level that captured 38% of US adults as at least pre-diabetic. Upon a more judicious analysis, it became clear that by setting the sensitivity level too high, far too many people were diagnosed and ended up having all sorts of further diagnostic AND unnecessary workups. The reason I recommend reading the article is this issue – the balance between specificity and sensitivity is the crux of why we need to be moving toward a “value-based care delivery model” of healthcare not only in the USA but around the world. Consider it…