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Comment end of life medicine is expensive (Score 5, Interesting) 651

In Australia, the last time I looked, around 90% of the lifetime medical expenses is spent on the last year of life. This has been true for decades.

You think you are doing good stuff, but all too many suffer and die. As a GP, my role is to keep folk alive. If I was a complete rationalist, I would work out some way of stopping useless treatments, but unfortunately that is usually only obvious in retrospect.

I counsel folk on the pros & cons of cancer treatments.

Sometimes it is obvious you are flogging a dead horse, and really they should pull out and enjoy their last days in comparative health, without the misery of chemotherapy et al, with the horrible side effects, and before you recover, the cancer catches up to you & you die in continued misery. I kept one of my mates out of lung cancer chemotherapy (in this case there really was no chance), and he enjoyed his last few good months without being stuffed by chemo. His family still thank me years later.

Then there are the less obvious cases, where the therapy may help, but usually just adds to life's burden of misery, worst just before they die.

Then there are the successes. They are wonderful, but not that common.

Sure, some guys making chemo drugs make a lot of dollars, but what drives most medicos is that we care, and we are not very good at pulling back when things are hopeless, because sometimes we succeed.

Comment Why would anyone want to use lousy software? (Score 2, Interesting) 294

However, the biggest stop to systems like this is the medical staff. Doctors seem to think they're above having to enter medical details - as it's mere clerical work (I've heard: "I didn't spend years at med. school, just to be a secretary") and they, personally, don't gain anything from a system such as this. Until somoeone gieves the profession as a whole a kick up the rear, this kind of prima-donna attitude will prevail.

I speak as a general practitioner of many decades, and I've been playing with computers since the early 70's. The main reason medical records software is not accepted is that it sucks.

My 24" screen holds far less information than a bunch of scribbled A4 pages. Time is what I lack, and scrolling through pages & sections on a screen is just not very efficient.

Yes, there are some great aspects in most of the software I have used over the last decade, but as far as being a place to store info that I want to easily access & collate later, all too often it is too bloody slow & awkward.

Except for one feature of electronic records, I would go back to pencil & paper.

The only really successful feature was the first; writing scripts & recording the fact that a script was written. In the 'old' days, you would write a script, then the phone would ring, on hanging up, you forgot to record what you had just prescribed, leading to problems down the track. Software to prescribe & automatically store a record of that transaction has been fantastically useful for both myself & the patient.

I have sat here for some 10 minutes, and the only other feature I like is that my notes are more legible to me down the track. As a computer nerd, I want to love these systems, but so far they are not very good.

Comment Re:A rant (Score 1) 565

> A...Goddamn people, I swear we are getting as blase about fixing bugs as a Microsoft shop. There is no such thing as a good bug, a less important bug, etc.... ?

Try Debian Linux. There are 3 main flavours.

1) unstable - pretty much the latest software, has bugs, can crash.

2) testing - lasted in 'unstable' for awhile & survived. is pretty good for most desktops, rare crashes, but fairly up to date.

3) stable - tried and tested. stable, but usually an older version. use it when your system MUST work.

You can pick your own trade off between stability & the latest software. Personally, most of my system is 'testing', with a few favored applications from 'unstable' for the latest features. If they crash, you can always go back to the less feature full, but more stable option.

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