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Comment Re:you mean capitalism works? (Score 1) 372

I prescribed a vial and syringes a few hours ago. Not an EpiPen; in my case it was for a similar (but less sexy) scenario, naloxone, to use for opioid toxicity, a popular cause of death among opioid addicts and even those prescribed opiates for legitimate use. (The current recommendation is to prescribe an opiate-antagonist for those using over 50 morphine equivalents a day.) I just hope to heck if my patient ends up over-gorked on their meds they can find the syringe and draw up the medicine. (Injecting it is the easy part; you could do it through your pants blam! into the leg.) You can't keep a regular syringe pre-filled safely - the medicine doesn't stay safe. Luckily, naloxone doesn't need to be dosed carefully. Epinephrine does (too much could fry your heart). I suppose it's not so importnat to be precise as it is for insulin, but most people don't need to draw that up in a hurry.

Ask Slashdot: Why Did 3D TVs and Stereoscopic 3D Television Broadcasting Fail? 435

dryriver writes: Just a few years ago the future seemed bright for 3D TVs. The 3D film Avatar smashed all box office records. Every Hollywood studio wanted to make big 3D films. The major TV set manufacturers from LG to Phillips to Panasonic all wanted in on the 3D TV action. A 3D disc format called Blu-ray 3D was agreed on. Sony went as far as putting free 3D TVs in popular pubs in London to show Brits how cool watching football ("Soccer" in the U.S.) in Stereo 3D is. Tens of millions of dollars of 3D TV related ads ran on TV stations across the world. 3D Televisions and 3D content was, simply put, the biggest show in town for a while as far as consumer electronics goes. Then the whole circus gradually collapsed -- 3D TVs failed to sell well and create the multi-billion dollar profits anticipated. 3D at home failed to catch on with consumers. Shooting genuine stereo 3D films (not "post conversions") proved to be expensive and technically challenging. Blu-ray 3D was only modestly successful. Even Nvidia's stereo 3D solutions for PC gamers failed. What, in your opinion, went wrong? Were early 3D TV sets too highly priced? Were there too few 3D films and 3D TV stations available to watch (aka "The Content Problem")? Did people hate wearing active/passive plastic 3D glasses in the living room? Was the price of Blu-ray 3D films and Blu-ray 3D players set too high? Was there something wrong with the stereo 3D effect the industry tried to popularize? Did too many people suffer 3D viewing related "headaches," "dizzyness," "eyesight problems," and similar? Was the then -- still quite new -- 1080p HD 2D television simply "good enough" for the average TV viewer? Another related question: If things went so wrong with 3D TVs, what guarantee is there that the new 3D VR/AR trend won't collapse along similar lines as well?

Comment Re:That's nice.... (Score 2) 30

Blowing my mod points for the opportunity to clarify why we screen for diabetic retinopathy: By the time a diabetic patient has visible diabetic retinopathy, laser photocoagulation treatment cannot always repair the damage. The goal is to find the bleeding before risking significant visual loss, when treatment tends to be more successful. This is why most organizations (like the American Diabetes Association) recommend yearly dilated eye exams for diabetic patients. Unfortunately, screening can be expensive for underinsured or uninsured patients, or those without access to ophthalmologists or optometrists. As a primary care physician I asked if I couldn't get trained myself to save the cost for my uninsured patients, and got basically a bunch of eye-rolling. Somewhat like neuropathy, you don't want to be able to self-diagnose it: you want to prevent it before it becomes noticeable, which is awfully close in many patients to the point of also being irreversible. Diabetic neuropathies tend to be easier and cheaper to diagnose currently and don't need a specialist (and could probably be done by patients themselves with monofilament examinations). The same isn't true for the eyeballs —yet.

IT Workers Facing Layoffs Jolted By CEO's Message ( 414

HCSC recently announced layoffs for more than 500 IT workers, and expects them to train their replacements from an India-based contractor. But a few days earlier, CEO Paula Steiner said, "As full-time retiring baby boomers move on to their next chapter, the makeup of our organization will consist more of young and non-traditional workers, such as part-time workers or contractors." dcblogs quotes ComputerWorld: What Steiner didn't say in the employee broadcast is that some of the baby boomers moving "on to the next chapter" are being pushed out the door. "Obviously not all of us are 'retiring' -- a bunch of us are being thrown under the bus," said one older employee.
The insurance provider argues that its members want easier technology solutions that "help keep rising costs in check. Our IT teams are being transformed...focusing on those and other member needs." But Slashdot reader ErichTheRed writes: Having a CEO actually say in public that their company wants to engage in age discrimination and eliminate full-time employment, rather than just carry out the work in secret, is new to me... for those mid- to late-career technical folks, how have you managed to adjust to new realities like this?

Comment Re:Thank you Democrats? (Score 3, Informative) 326

Good intentions, maybe, and despite the grief there are some advantages. I can see my patient's clinic charts in the hospital - before, I'd have to wait for Monday and a fax machine. I can see what happened to folks in the emergency department. I can figure out my obstetric patients' prior pregnancy history. I can send records to specialists directly, and send requests with an electronic copy of a chart note and pictures of moles and whatnot at no cost to a patient and sometimes save them a visit to another office.

It's not perfect, but it's not a total disaster either.

Comment Re:Burnt out doc here: (Score 2) 326

I like a conspiracy theory as much as anyone, but I really don't think the NSA convinced Congress to pass the not thoroughly thought out HITECH Act to amass statistics about the home addresses of people with pneumonia or which patients with high blood pressure are smoking. Being able to gather anonymized statistics on public health issues may help, however, to figure out how to improve immunization rates or best help diabetics get their blood sugar under control.

To the grandparent poster, our EMR company actually will pay their own way to have their engineers follow us around and see how we work, and our prior vendor was originally a nice internist who wrote his own code (who then sold the thing to a big conglomerate that also makes microwave ovens and jet engines and curling irons and stuff).

Our current EMR does a lot of stuff well, but I'm hopeful for the day it's more usable by clinicians. The basic process of writing progress notes (in some sense, the evidence of my life's work as a physician) is clunky and hard to correct and even less intuitive for my colleagues who don't happen to have fancy computer science degrees like me. Writing good software is hard, and maybe progress notes have had to wait in line behind revenue cycle and privacy and a bunch of compliance issues.

Comment Re:Uneasy About Starting Without a Physician (Score 1) 301

As a physician practicing in a US state (Oregon) where oral contraceptive pills are available behind the counter, I'm all for expanding access to contraception. Nothing quite has made otherwise young, promising women be overwhelmed in my practice than unplanned pregnancy (combined with flaky partners). OCP's are available here without a prescription, but require a consultation from a pharmacist. This isn't free, but where they make sure you don't have any of the various risk factors for having a stroke or blood clot on estrogen-containing contraceptives.

I'm also in favor of expanding access to more effective forms of contraception, like the subdermal implant (sold as Nexplanon in the US), and IUD. I'm pretty puzzled, however, about how one would implement an app to jab the implant in your arm. It's not hard to do (see this video), but clinicians have to get special certification from the manufacturer to do it. (This is to avoid the Norplant debacle of inadequately trained people putting the rods in a little too deep, making eventual removal challenging.) I do love the idea of having etonorgestrel rods and lidocaine hooked up to a smartphone app, however.

Comment Re:War Story on Medical System Security (Score 2) 85

Epic is a big suite of applications that run on top of a big iron server - typically Unix (ours is AIX, I think). There's fine-grained user permissions in the application itself. End users do not have shell access or filesystem access or MUMPS prompt access, and everything has an audit trail. A select group of IT nerds get access to a text-based system running as a (Unix) application (with audit trails), and, at least at our organization, next to no one gets MUMPS prompt access or shell access. We have hot swappable servers located on opposing coasts of North America. I can't speak to the implementation at your daughter's site.

There may be examples out of there of hackers breaking into Epic; I'm not aware of any. Since our implementation was modeled after Epic's recommendations my impression is they've got their heads screwed on straight, security-wise.

Comment Re:There might be a problem with... (Score 1) 265

Good luck getting EMR applications disconnected from the Internet. Every institution I know of has their EMR available behind a firewall, accessible visa Citrix. So we can work on our charts after putting the kids to bed (not uncommon for that to be a 1-2 hour task) and covering our partners during overnight call and answering emergency calls when out of town. And for seeing patients in nursing homes, and home visits (they still happen!). And our EMR's exchange information with one another, so if you go to hospital X in my town and then show up in office Y to follow up with your regular provider we can tell what happened Or, I dunno, I suppose you could keep us (physicians) locked up in the office for 24 hours 2-3 days a week and for 14 hours (instead of 12) on non-call days. I know, boo hoo hoo, but I think this horse has left the barn.

Comment Re:Document2 (Score 1) 265

When I worked as a software engineer, typed my password in for various ssh sessions maybe 10 times a day. Now that I'm working as a physician, every time I walk in and out of a patient room (which can be multiple times for visit, fetching the liquid nitrogen and scalpes and where are we keeping the extra large speculum this week anyway). I get to type in my (Active Directory) password with its enforced mixed capitals and numbers that I'm not allowed to change (too many disparate systems, apparently), maybe 50 times a day.

Which doesn't help with the spear-phishing, right? That just requires that I click on the link in the email addressed from my information security department, complete with their logo, saying they need to verify my information. I don't think my clinician colleagues are falling for that much, but the folks who answer the phone, hired out of high school, it's easy enough for them to fall for it.

Comment Re:Never mind his face, I don't like him. (Score 3, Insightful) 203

Or it means you had diabetes (and there are plenty of thin, otherwise people with diabetes) and didn't work for a company that offered health insurance;

Or it means you had a (now illegal) plan that "covered" well child visits, just not more than 2 in the first two years of life (out of the 9 that are the standard of care);

Or it means you fell off a ladder painting your house and broke your back;

Or it means you have congenital heart disease —

SORRY SUCKERS! You shouldn't have had Pacific Islander grandparents/been a kid/painted your house/been born — not my problem! I'm not saying "Your problem, not mine" isn't a valid viewpoint, but I do think that letting people who have treatable medical problems through no fault of their own drop dead in the streets is a bit more individualistic than all but the most libertarian viewpoints in the US. Not to mention every single other developed nation on the planet, that somehow manage to have popular support for their universal health care systems yet still spend about half of what we do.

Comment Re:Under supervision (Score 1) 82

I am interested in this 1 and 1.5 year time for PA and MD programs. Our local PA school provides a 26 month course (done in just over two years), and MD school is 46 months (done in 4 years, but you get two summer breaks the first two years). But at the end of MD school, the shortest available residency is still 3 years (of about 80 hours a week with little vacation), whereas the PA education pathway is not typically associated with residency programs. Those are growing, but are still typically a year long.

I suppose autonomous robot surgeons may arrive someday, but it's hard to believe that day would arrive any time soon. Getting your Google car to avoid knocking over granny in the crosswalk is one thing, but getting a baby with a typically soft skull wedged out of the pelvis during a C-section or figuring out where the heck the bleeding is coming from from a sheared artery somewhere deep inside with no time to spare —that seems well beyond our current robotic capabilities.

Comment Re:Who still uses pagers? (Score 4, Interesting) 307

I'm a doctor, we still use pagers, and they suck. On the plus side, an AA battery lasts a month, and reception is not usually an issue. On the minus side, no one seems to be making pagers anymore, so we get reconditioned units. I long for my old indestructible Motorola pager. Buttons get jammed and latches fall off the "new" ones, the display is less than reliable, and I can customize the beeping to grating, annoying, and nerve-wracking.

We are beginning to investigate smartphone based solutions, which, in order to be compliant with US privacy regulations have expensive recurring monthly charges, and will involve installing and maintaining microcells in our hospitals.

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