Experienced Docs Are Best?

Just watched a really interesting video from the Yale Cancer Center.

It's a lecture from their Grand Rounds series, featuring Dr. Scott Huntington, an oncologist and lymphoma specialist.

"Grand Rounds" is a kind of lecture for medical students and working doctors. When a doctor "does rounds," it means visiting individual patients. When this happens at a hospital that is connected to a medical school, it often means having some medical students tag along to observe. (I'm sure this has happened to many of you, with good and bad results.) "Grand Rounds" are a way to present information without having a few dozen people crowd into a patient's room. One doctor presents a lecture, and everyone who attends gets the chance to learn. It's a good thing.

This Grand Round is called "Provider Volume and Cancer Outcomes: Moving beyond surgical settings and into the increasingly complex field of medical oncology." The video is about 25 minutes long, and I found it pretty interesting.

"Provider Volume" is a way of saying "doctor experience" -- a provider with greater volume is one who has more experience with a particular treatment. And as the research presented here shows, more experience can mean better patient outcomes.

The example that stood out for me had to do with Rituxan. (Naturally, I find that fascinating, since Rituxan and I are good friends.)

As you may know (maybe from experience), many patients have an allergic reaction to Rituxan during the first or second dose. It is usually taken care of with Benadryl and/or steroids, and the rest of the doses work out with no problems.

The research looked at a database of lymphoma patients who had given Rituxan (18,570 of them), and measured how many of them stopped treatment after 1 or 2 doses. The assumption was that patients who stopped early probably had doctors who were less experienced (that is, had a lower provider volume). A doctor with less experience giving Rituxan might not understand that, as long as the patients can be treated with something fairly easy, then rounds 3 through 6 or 8 will go much easier.

And that's exactly what they found -- about 7.6% of patients stopped early, compared to 1-3% in clinical trials. Doctors who had not given Rituxan to any patients were 57% more likely to stop after 1 or 2 rounds than doctors who had given Rituxan to 3 or more patients in the last year. Experience -- provider volume -- matters.

The next step in the research is to make the experience better for patients. The researchers are testing out a system where doctors who are inexperienced with a treatment will be given data that shows how other doctors have handled the situation. So instead of stopping the Rituxan early, they'll know that Benadryl or a steroid has worked in some percentage of cases. They'll be able to use other doctors' experience when they don't have their own.

It's a nice example of "Big Data" -- the term used to describe statistics that involve huge numbers of people -- being used to hep single, individual patients.

That's the goal.