Wednesday, July 30, 2014

Ultrasound selfies? How surveys can mislead

Do you believe that traditional hospitals will be obsolete in the future? A recent survey found that 57% of those polled believed that would happen.

The survey, sponsored by the Intel Corporation, involved 12,000 subjects from the United States and seven other countries around the world.

Here are some other revelations from that survey:
  • 84% said they would be willing to share their personal health information to advance and lower costs in the health care system.
  • 70% said they were receptive to using toilet sensors, prescription bottle sensors, and swallowed health monitors.
  • 53% said they would trust a test they personally administered as much or more than if that same test was performed by a doctor
  • 30% of people would trust themselves to perform their own ultrasound. 
That made me laugh. Ultrasonography is one of the most operator-dependent tests in use today. It is not easy to perform, nor is it easy to interpret.
I then began to wonder about the credibility of this survey. Before I retired, I practiced in a typical small town in the northeastern United States. Some patients googled me, and a few searched the Internet for information about their illnesses. But for the most part, it was a technologically unsophisticated population.

I just can't envision most of my patients wanting to share their personal health information, use toilet sensors, or trust tests they did at home. Do their own ultrasounds? Not likely. Many of them did not even know what medications they were on.

After rereading the article about the survey, it occurred to me that the sample may have been flawed.

This sentence stood out. "[The] Intel Health Innovation Barometer was conducted online by Penn Schoen Berland in Brazil, China, France, India, Indonesia, Italy, Japan and the United States." The key word is "online."

This reminded me of a famous survey conducted by a magazine called The Literary Digest, which polled 10 million people and had a response of 2.4 million just before the 1936 presidential election. The magazine had correctly called the previous four presidential winners.

The names of the 10 million people queried were drawn from lists of the magazine's subscribers, owners of automobiles, and those with telephones. The survey predicted a crushing defeat for President Franklin D. Roosevelt at the hands of the Republican nominee, Alf Landon.

Of course, the opposite occurred. Roosevelt won all but 8 electoral vote, a huge landslide. What went wrong? Unlike the prior years, 1936 was the middle of the Great Depression, and this time those who had enough money to subscribe to The Literary Digest, own cars, and have telephones were not a representative sample of those who voted.

Do you think maybe the 12,000 people polled online might not be a representative sample of the general population of the world?

I'm not expecting patients to do their own ultrasounds anytime soon. I think hospitals will be around for a while too.


Libby said...

I'd pay to watch someone do their own bilateral hip ultrasound!

I just chose not to do an online survey about my alumni magazine because I would have to choose between "what the heck" and "maybe this" when answering. I'm thinking that many, maybe 30% didn't have a solid clue what is involved with doing an ultrasound and maybe about 53% don't have a lot of experience with medical tests outside of supplying an urine sample (how hard could it be to do a stress test on yourself?).

Definitely a flawed survey, but worthy of a late night talk show host mocking them.

Anonymous said...

My hunch is that the point of the article is to show just how super duper disruptive Intel is.

The etnographers found much higher acceptance of gadgetry in rural India, where they have severe logistics problems. Of course people over there would be interested in having health services delivered to their homes via some fancy gadget and even willing to swallow weird sensors to get some kind of care. As education levels are also lower and available hospitals are probably low-tech, it's quite possible they believe the new tech will entirely replace hospital care.

Regarding ultrasound specifically, I suspect many of the interviewees believe that the machine spits out the diagnostic by itself.

Finally, the more liberal attitudes to sharing medical records outside the US also make sense because concern about losing insurance due to pre-existing conditions is more prevalent in the US than among people who do not buy private coverage--either because they're too poor or because their contries run national health systems.

Skeptical Scalpel said...

Libby, thanks for commenting. I agree it would be fun to watch people try to do ultrasounds on themselves.

Anon, you may be right about Intel's motives regarding the survey and the acceptance of home diagnosis by those outside the US. You made some good points.

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