Concept of "Long Tail"

"The phrase The Long Tail was first coined by Chris Anderson in an October 2004 Wired magazine article to describe the niche strategy of businesses, such as Amazon.com or Netflix, that sell a large number of unique items in relatively small quantities. However, the concept of a frequency distribution with a long tail — the concept at the root of Anderson's coinage — has been studied by statisticians since at least 1946."I think “long tail” concept is very illustrative and informative. As physicians we often provide great value to individual patients when we keep the long tail in mind. We all can acknowledge this. There are serious system downsides, though. I would argue, as a profession, we tend to operate on the long tail excessively for patients who are “short tail” patients. The amount of medical testing and treatment we do dwarfs the expected benefit for many patients. Every renal consult gets a renal US, almost every cardiology consult gets an echo, every ED evaluation of delirium gets a head CT, and most chest pain gets an admission and rule out MI. Certainly we should expect some negative testing to rule out disease, but it is a matter of degree. Coming up with a long differential diagnosis is a valuable skill. Testing each of those hypotheses indiscriminately with expensive medical imaging and blood testing is a failure of judgement. We are way out of step with regional and international spending without any major differences in outcomes. We have problems restricting our workups on many patients who are overwhelming likely to be short tail patients, in an attempt to either a)find a long tail disease or b) avoid a missing something. The balance is the key, but without incentive and/or legal protection to perform judicious testing, we are contributing to the bankrupting of our society. And I think the emphasis in our teaching institutions has not been on judicious application of testing, but on thoroughness (with an emphasis on ruling out long tail diseases). When many physicians see routine problems they revert to robotic thinking. Many non-physician experts think that we can just develop algorithms for episodic care. That works most of the time. However, most of the time is not good enough. That is the point of long tail thinking. I have to be better than 85% when I care for you. Robotic thinking covers around 85%. Our value comes not in robotic attention to details but rather in recognizing the long tail. Sometimes we can make the long tail diagnosis ourselves; sometimes we need to find the right consultant. Either strategy works well. The key is knowing that the patient needs cortical attention rather than brain stem reflexes.

Entering the long tail zone by over at DB's Medical Rants