Me(2010 ish): Hey can I get my x-ray pictures before I leave?
Doc: No, there's no way to get pictures off of this computer
I had the pictures saved on a flash drive about 30 seconds after he left the room. They were using some awkward browser-based system where everything was served as an html page. It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.Just a personal anecdote.
Wait - you accessed your doctor's computer after he left the room and downloaded data from it?
It’s even more concerning you obtained access to this system with ease. Sounds like a pretty serious security incident.
Something my doctor friends remind me of from time to time is how disconnected their actual workflows are from whatever system the money folks decided to buy.
People making the purchases are not the ones using the system and they hate it because it doesn't serve them... A tale as old as time.
For example, one of my doctor friends mentioned he has to scroll past an "order birthday cake button" at the top menu level so he can get to the order tests section and drill down to actually order tests.
I read elsewhere on HN - "Well-meaning users will always quickly turn an unusable secure system into a usable insecure system."
I'd order birthday cakes daily just to prove a point
The doctor I've been with since 1998 has refused to adopt the digital system. He's getting older unfortunately and I suspect in another few years he'll be retiring only to be replaced by a doctor who embraces digitalization. It's far and few these days to find paper only offices. Which is a shame, as I feel the more modern the medical system is the less personable, less "family doctor" oriented, heck more often only to be bought up by a network. Quaint is under rated, futurism is over rated.
Dentistry has changed in the last decades. If a dentist refuses to use useful computer things, I instantly wonder if they are also out of date with modern best practices. Better materials for infills and stuff like that.
I'm in the process of having some dental implants done and the process is amazingly high tech - I was particularly impressed at the 3D model they created from CAT scans that they then use to position instruments during work - they attach something to my teeth to tell where my head is and the software guides where the instruments should go based on 3d sensors.
Wouldn't surprise me if they went fully robotic for some things in the not too distant future.
Why would my care be better if a doctor goes through a paper folder instead of a digital one?
It’s not how the records are kept per se.
It’s that the paper-using doctor can spend more time on you, the patient, instead of fighting with a balky UI and inane business rules.
A relative of mine had to go back to their paper-only specialist a couple of months ago to get a prescription reissued because the specialist had omitted a mandatory detail from the (handwritten) prescription form and the pharmacist couldn't fill it.
Meanwhile, I had a similar prescription, from a different specialist, who issues his prescriptions as either e-scripts or computer-generated paper scripts depending on patient preference. I suspect his practice management software would stop him from making this class of mistake entirely.
I get why a doctor might prefer to avoid the computer, but I think my relative would have preferred their doctor not screwing up on something basic and wasting a significant amount of their time over better vibes in a consult.
Why would that necessarily be the case? I understand that bad software can get in the way of anything, but I find it hard to imagine there is nothing out there that actually helps any given (and willing) physician to improve their work, and make more time for patients, not less. There are inherent properties to IT that can help make stuff more efficient across any domain I can think of, and physicians work checks a lot of the marks.
I happen to work in the medical field and while a lot of the software involved has its issues, not working with software, at this point, seems like a really bad idea, in terms of error prevention, performance and efficiency.
Not necessarily, no, but empirically yes.
Paper-shuffling used to be not a major issue in a doctor's work day. It was merely something that yes, sure you had to log new patient data and whatnot for reference, but you were mostly free to do the paperwork in a way that fit your natural workflow. Based on the doctors I know/knew, it was not a pain point. Yeah, you would sometimes have to fetch physical papers from somewhere instead of clicking yourself to the same information on the computer, but that was not a major issue. I'd say it was similar to a programmer who's waiting for an incremental compilation to finish: a minor moment out of actual work but nothing to fret about.
After doctors' offices got digital then interacting with the computer specifically certainly became an issue which didn't exist before. At best, it was just a clumsy way to do the inevitable and at worst it became a major part of the patient visit, with myriad of odd tricks you had to learn about some particular computer software in order to accomplish your actual goals.
If something that used to be normal part of work nobody thought twice about once become noted as a separate issue of the work day, something did change there. Sure, there are benefits too, but it's the friction points that you feel at work when you're trying to get other things done. Sure, software could be written to serve the user and not the other way around, but software rarely is -- no matter the profession, doctors aren't the only ones!
My old family doctor used to have IBM terminals into the early 2010s, I'm fairly sure there was an AS/400 somewhere in the back rooms where all the serial lines in their practice converged. Very fast system. Meanwhile I was at a specialist some time ago and they had to switch back and forth between notepad and the medical app, because you can't enter more than a few words at once into the app. So he would write everything that's not a drop-down in notepad then copy-paste it.
I'm a physician. To understand why this is true you have to understand that the software is not intended to the make the physicians jobs easier or more efficient. The point of modern EMR's is to take every patient encounter and generate a list of billable codes that maps onto the encounter in such a way that insurance companies are less likely to send it back. The stuff like checking medication interactions is just tacked on as an afterthought. Through this lens everything else makes more sense.
Well for one thing it's much less likely for someone to steal 36000 therapy files and extort people into suicide when they're stored decentrally on paper in locked cabinets instead of ~~the cloud~~.
Not sure what being personable has to do with knowing how to use a computer.
This has nothing to do with "knowing how to use a computer."
Looking at a screen while you check through dozens of flags and billing related documentation instead of looking at the patient is much less personable.
could it be that wasted time and added stress make you less empathetic?
I can see that working today in dentistry more so than general practice. I’ve got medication that insurance has dictated that I need to refill a weekly med monthly and it arrives precisely the week I need to take it. I need to time my vacations around this med now.
I get that I’m ranting against healthcare and not doctors, but I’d run far from any doctor that’s paper only these days.
My dad practiced dentistry since the 70s and never digitized his office. Every patient had a folder. There was a phone, a typewriter, and a calendar. I don't know how insurance claims worked, maybe by post.
When I moved to New York I was surprised to find a dentist whose practice was much the same, though he did have a few computers around. He retired recently.
Computers no doubt can improve things; a lot of it seems like a no-brainer. But I'm starting to doubt that they're there to improve things.
Dental software is terrible as far as I can tell. I’m at school /practice were the staff cheered loudly when it was announced they were planning to upgrade or change vendors.
I never saw such passion about software.
It's not just filing the X-rays. Back in the day, for a big crown you got yourself a full mouth cast, ship it away, and eventually you got a crown which hopefully fit. Today you get a much less invasive scan before the root canal. one after, and the 3d printer in the back creates a crown that fits. Much faster, cheaper and typically even more accurate.
My dentist uses a software that seems pretty efficient. All the x-rays and other notes are right there. One big plus is that the screen is faced towards me so I can also see what they are doing.
to quote Wendell Berry, “the more superficial and unsatisfying our lives become, the faster we need to progress"
> Computers no doubt can improve things; a lot of it seems like a no-brainer. But I'm starting to doubt that they're there to improve things.
They stopped the improvement around Win 10. Since then, everybody (Microsoft, linux, Apple - Google never had a wheel) is reinventing a worse wheel, regularly.
For me, the most interesting part is about 4/5 of the way in and starts with
> Some people are pushing back. Neil R. Malhotra is a boyish, energetic, forty-three-year-old neurosurgeon who has made his mark at the University of Pennsylvania as something of a tinkerer. He has a knack for tackling difficult medical problems. In the past year alone, he has published papers on rebuilding spinal disks using tissue engineering, on a better way to teach residents how to repair cerebral aneurysms, and on which spinal-surgery techniques have the lowest level of blood loss. When his hospital’s new electronic-medical-record system arrived, he immediately decided to see if he could hack the system.
A great example of participatory design.
Popular in:
2023 (100 points, 116 comments) https://news.ycombinator.com/item?id=36903220
2020 (279 points, 319 comments) https://news.ycombinator.com/item?id=24336039
2018 (157 points, 109 comments) https://news.ycombinator.com/item?id=18381969
Check out this blog for the best summary of why data has hurt medicine and insurance https://yuzu.health/blog/ai-will-not-fix-healthcare-admin.
The company Yuzu is hiring too. Worth reaching out if you care about how to fix this issue.
All of my doctors for the last five years (Kaiser and Sutter) have no problem with their computers. When I switched from Kaiser to Sutter, the doctor showed me "how easy it is to transfer my full records" (they both have Epic, plus a custom integration). I have no trouble communicating while they use their computer, and handle just about everything through the captive website (which is a bit slow- sometimes the pharmacy faxes a request to my doctor, who ignores faxes until I ping them).
The one important thing is to know how to work the system. Once you understand how it works, it's remarkably easy to guide your doctor or other service providers to do what you want. I talk a lot with the doctor and my spouse (who has taught me a lot), and I also read various online forums. Further I have no truly serious health problems that require intensive care, which could change things a lot.
I understand many people feel differently, and I in no way want to invalidate their subjective experience- if you prefer paper, or find computer doctors impersonal, or anything else, I'm not here to try to convince you otherwise.
My personal feeling is that medical practices have not evovled too fast with computing. Electrical engineering, mechanical engineering, biomedical engineering etc all contributed a lot to how doctors treat diseases. But whether medical records are digitialized or not is not significant. It helps, but does not increase cure rate. Old fashioned doctors have good reasons to reject. But they do not say no to new medicine, new devices, new procedures.
I fully reject your statement about not digitizing being insignificant. And there are several reasons for it, but the main one in my mind is about prevention vs curing.
In an ideal world where every medical record is digitized it would be possible to discover long term causal effects that nowadays we don't know because running long term studies is hard, costly, and in a world where publishing is everything they don't lend to it. So we explored and confirmed only the most obvious long term cause-effect connections.
Therefore, it would enable prevention of some diseases for which we, nowadays, can only have a reactive MO.
> it would be possible to discover long term causal effects that nowadays we don't know because running long term studies is hard,
Companies sell the data to ad companies, before any meaningful research can be done.
Fair, but I said "in an ideal world". Also, not sure if selling ads is more profitable to a product like a supplement because mining the digitized medical records showed that (example I pulled out of thin air) "constantly low potassium increases Alzheimer incidence by 50%" or similar.
> My personal feeling is that medical practices have not evovled too fast with computing.
You should see "computing". Resizing a window in Windows has become a lost battle. Working with files on Android is a torture. I really hope that "medical practices" will not "evolve", like "computing" has.
Ehh, I think there’s a pretty consistent pattern of doctors rejecting pretty basic technologies or procedures that lead to positive outcomes for patients if it’s seeking to address the fact that doctors are human beings that can make mistakes. Medicine is a field full of massive egos.
Yeah I mean let's keep in mind that the man who found hand washing stopped patients dying of infections was roundly ignored [1] for too long.
There appears to be (almost) no true competition in healthcare, therefore no real incentives to improve productivity. Wages in healthcare rise disproportionately without productivity gains (Baumols disease); why invest in digitalization?
Wages in healthcare have decreased Year-Over-Year relative to inflation since at least the 90's. Productivity has increased in terms of the number of patients seen / day.
Competition isn't the only way to hold down wage costs in healthcare. The UK system involves a combination of monopsony and economies of scale. (I make no other claims about the pros and cons!).
I wish schools would stick to paper and pencil homework. Getting kids to stay on task using a computer is neigh impossible.
Yeah, it's hard to make them quit horsing around.
I wish they were actively taught how to stay on task instead of being shamed into it.
I mean they're being handed over / bring their own computer / have their phone at hand, and anyway they probably have all of that at home, and will have at work someday.
From that state of affair the best thing to do is to try and give then the tools to best manage and navigate the situation, not yell "stay on task" at them (which is AFAIK basically the only course of action) which is wholly unproductive.
For my xray stuff (broken ankle/leg and earlier badly broken arm) they all seem to love it compared with photographic plates. I like seeing it too, but of course they could do that with photos, but only after some time. Good to have it networked.
I've talked about it here many times, so I'll be terse. I really hate when I go to the doctor that they just sit there and type the whole time. Barely even look me in the eye. On more than one occasion I have had my doctor literally just Google my symptoms.
My experience as a software engineer tells me that there's a positive correlation between frequency of googling and caliber of engineer, I have no reason to presume that would be any different with doctors.
Medical scribes and ambient clinical intelligence systems that automatically transcribe doctor-patient conversations are addressing this exact problem, allowing doctors to maintain eye contact while still capturing necessary documentation.
> On more than one occasion I have just had my doctor literally Google my symptoms.
There have been times I wished they would have done that.
I expect them to be resourceful rather than know everything off the top of their head.
Med student here: oftentimes the attendings who are googling are usually doing it because the patient's symptoms don't fit with the most common illness "scripts" we develop in our mind and have ready for the 90% of patients who walk in the door. The google is a quick sanity check to see if these symptoms are within the range of "normal" for the most likely differential diagnoses (i.e. list of most likely diagnoses based on the patient's presentation).
That or those symptoms are exceptionally vague or uncommon enough that they warrant a quick refresher on google for leads on additional questions we should ask of patients (the most common offender here is rashes/skin lesions imo since they can literally be a manifestation of super simple "oh you just changed your shampoo" to "you have a rare autoimmune condition"...asking a comprehensive history from patients can help determine what tests to order).
and so here is the problem of personalised care in a system where you can see upwards of 30 unfamiliar people a day: sometimes patients would rather I look things up, and others hate the idea of me touching any sort of technology in their presence, and it's nigh-impossible to tell which they are until a good way through the interview.
Just replace typing with voice recognition, and you've got the perfect AI doctor already!
Patient talks about symptoms, doctor returns a markdown-formatted prescription. Charge by the number of tokens.
Soon we'll have the holographic doctor as seen in Star Trek Voyager.
Science fiction, particularly space operas, can be dismissive of doctors. Most of the time the "doctor" is just a diagnostic machine that gives miracle meds and maybe 3d prints new body parts.
Maybe it's prophetic: authors saw the writing on the wall and decided a doctor is a glorified mechanic who works on the most boring machine around (which hasn't changed in 100k years). Or maybe authors just decide the space was better filled by an ex-space-ninja or similar.
Don't pity or excuse the doctors, they're smart and they know what they are doing. If their workflows with computers don't work, it's only because they make more money from this situation.