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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
https://news.ycombinator.com/item?id=44778004
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
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.
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.
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).
Patient talks about symptoms, doctor returns a markdown-formatted prescription. Charge by the number of tokens.