I don't sneer at my patients in the ED (emergency department) when they say they've looked up their symptoms on the internet. Most of the time they have been looking them up in WebMD or other non-clinical websites that ultimately tells them that they are either having a heart attack, cancer, or our about to die. I hear them out and see what their worries are and attempt to assuage them of their fears. I'm hearing to teach them about their symptoms and get them involved in their care. There's nothing wrong with looking up symptoms but it is incumbent on us to teach patient where to look up this information, what questions to ask their doctors, and what to worry about or not worry about.

A major portion of the money that is spent in the United States healthcare system is for end of life care. No one wants their elderly mother, father, grandmother, grandfather, etc. to die and wants "everything to be done" despite our recommendations that these interventions will not prolong their life. See http://khn.org/morning-breakou.... The emergency department is most likely the most efficient part of our health care system. See http://newsroom.acep.org/fact_...

I am an ER doctor and I can say that this occurs throughout hospitals throughout the United States every day. I have friends who work in emergency departments (ED) who have such bean counters tell them to see more patients and admit or discharge patients too soon. I work in an emergency department that does not have these bean counters yet but we do have "patient satisfaction" scores based on Press Ganey surveys. We are graded on how well we kept patient informed, spent time with patient, our friendliness, our skill, etc. Patients can score us from 1 (poor) to 5 (excellent) in 7-8 different categories. Most give us 1s or 5s and those that give us low numbers go on to state in the comments that "I didn't get a blanket, water, pain medication, etc" fast enough or "doctor didn't care about my condition". Mind you, most of these folks should not be in the ED in the first place and are at most urgent care patients. No one cares that you were tied up in the back with 4-5 critical patients who are trying to die on us and that we were busy for the past 2 hours to get them up into the ICU with the appropriate interventions made so that they will have a successful outcome. Instead, people are pissed off that you didn't take care of them right away for their symptom(s) or condition(s) and don't care that you (I) was busy elsewhere.

This is the reality of medicine in the United States these days. A doctor who must appease every patient (paying or non-paying thanks to EMTALA) as a waiter must his or her tables so that our patient satisfaction scores do not drop appreciably or else the bean counters will not be happy. if the bean counters are not happy, then you will be looking for another job.

If you want to be treated as a real patient, you better start looking for direct primary care physicians who take your money on a monthly or annual basis. In exchange they will give you their undivided attention in the form of hour long visits, communication via email, and your ability to reach them 24/7 as needed.

http://epmonthly.com/article/2...

The replies below your brain-dead comment are spot on. Read a little bit more and get a better understanding before you speak up. It works in real life too!

EMTALA provides treatment, stabilization, and management regardless of the ability to pay. Emergency physicians among others provide at least $150,000 / yr of uncompensated care to those that don't have insurance, those that won't get insurance, or cannot afford health care.

Stop spewing crap if you don't know what they hell you are talking about! EMTALA is a federal mandate that any patient that presents to the emergency department regardless of ability to pay receives a medical screening examination, treatment, and management to stabilize the patient for either discharge, observation, or admission. Also, thanks for the retrospective look at how the physician and nurse dropped the ball when he first presented the first time to the ED. Everything is 100% accurate after the fact. Do you know how many people present to the ED with non-specific viral complaints? How do we know that he iterated / reiterated this fact to the physician that he saw during his first visit? My guess is that he didn't.

Medicine was never, is, and never will be a perfectly sensitive or specific process and there will be near misses and misses such as this. I'm an emergency physician and there are a lot of moving pieces in an emergency department that are not controlled by the physician, nurse or others. Shit happens, deal with it, and move on. To say that the nurse or physician needs to be fired is out of line and irresponsible. How would you feel if someone were to say that we need to fire dc29A for this one bug in the line of code that causes a crash when we hit this corner case?

I see it as an issue of low accountability for the most part, having different IT areas budgeted and the need to spend that budget before the year is out or otherwise we won't get the same amount of money next year. That's the mentality that most organizations take with silo-ing of budgets but to me seems to be a waste.

In my organization, they have outsourced the servers and support for the EMR to the EMR manufacturer for them to host in the "cloud" while adding more Citrix redirections and latency for the users. The entire EMR support staff is several orders of magnitude larger than the database / networking / software engineers combined. The people that they do hire to write support side software are imbeciles at best and have been here for several years -- no one is fired for incompetence but layoffs do occur.

Unfortunately, the higher ups in the C-level do not seem to understand the sandcastle that they've built within the hospital and IT department as their vision of what should be and the reality of it are completely divorced. I can see it as a physician with engineering and consulting experience who works in the ED day in and day out but the C-levels who are mostly non-physicians do not see the cruft that's built up or the inefficiencies that they have introduced.

If I had my way, I would bring everything in-house, bring in more open source systems, and hire engineers to write custom applications. Nonetheless, there is so much you can do when your ONE community hospital.

As to IT supporting its users, the issue is very simple and cuts across the entire healthcare system. Engineers do not talk to clinicians about the systems that they build and in so doing build clinical systems for engineers. I understand the mindset but as a emergency physician that has to see many patients in the day, the system that they've hoisted on us becomes a PITA to work with as the workflow I have created for myself does not equate with the workflow software engineers "think" that I should have. I want more input from physicians into the systems that are built. I want the engineers to come to the ER or to the inpatient floors or to the office to see how we work and help us perform in efficiently and safely.

As an emergency physician and former IT engineer with Unix system administration background, I'll say that most of the important software and hardware choices are made by the IT department and C-level executives without any input by physicians what-so-ever. I'll reply to your points line by line:

> 1) Over emphasis on the needs of the physicians over the needs of the patients and the other areas of the healthsystems. Many important IT choices are > made by doctors and not the professionals who were hired to be experts in these areas. That and the physicians are notorious for having almost no respect > for other professionals who are not a doctor.

The healthsystem SHOULD EMPHASIS the need of the PHYSICIAN over that of the patient when we are the ones using the EMR, PACS (picture archiving and communication system), network drive, intranet, and other features day in and day out. The needs of the patient come into play when interfacing with these systems to retrieve their laboratory and imaging results, physician communication, and others when at home or elsewhere. If the IT department doesn't like this, then too bad as the users needs outweigh yours -- remember that this is coming from a practicing clinician.

Just keep trotting out the old-line about how physicians have no respect for any other professionals as there's no basis for it in the real world. If you look around at the landscape of healthcare in the US, you'll see that it's the physicians that are dis-respected every day at the hands of the administration, fellow professionals, and patients.

http://www.thedailybeast.com/a...

> 2) Easy money. Money comes easy to these organizations. This plus...

Money does not come easy to any of these organizations unless your are a huge health system such as Mount Sinai in NYC or Mayo Clinic or any of the other health systems around the country. If you're that big, you can tell the insurance companies how much they will need to pay up. However, the majority of hospitals are 1-2 hospitals and have a very limited budget for many things including EMRs, IT staff and departments, and ultimately hardware and software. It's not like they have money to burn...

> 3) Non-profit tax status and requirements to spend or invest profits earned. This creates an environment of plentiful budgets where waste runs rampant, and > concern over things such as nepotism and incompetence aren't as important as they would be in other companies

IT departments in hospitals are rampant with nepotism, incompetence, and wastefullness. The heads of the security, network, and support divisions have no clue when it comes to support clinicians including physicians, nurses, LPNs, or any other staff that requires using the computer for any health related work.

You do realize that a part of that $80K needs to go into 401K for retirement and don't forget that for the last 7 to 12 years of training that the physician did not earn enough money to put into their retirement account while still accumulating debt. From my own perspective, I now have > $300K in debt that needs to be paid off and I have not a single piece of wealth to show for it. I don't have a car, home, retirement account, stocks / bond, or anything that I can hang my hat onto if the proverbial shit hits the fan. It's folks like you that don't understand the amount of time that we put into medicine, lose out on opportunities during training, and come out the other end with significant debt load. You despise us for the incomes we make but fail to gauge the above.

As a physician working with other physicians daily, I don't perceive us as being unscrupulous. We didn't go into this career for the money or accolades but to help people but that doesn't make us immune from daily life including requiring payments to make a living (have you noticed how much our loans are in the US? That we don't effectively earn a living until after 4 years of medical school and 3+ years of residency.). Please don't equate big pharma and the small minority of unscrupulous physicians with the rest of us as it does the rest of us a disservice.

Here's a list of Ubuntu hardware partners including Dell and Asus and their products. I'm not sure why you're blaming Canonical when the vendors are responsible for putting the hardware out.

I'm a doctor who is involved with the hospital's IT and EMR. The cost of switching over to electronic records is an already expensive proposition at the beginning and where the vendors get you is for maintaining the EMR on a yearly basis. Yes, it is minimal labor and not many pages but it is NOT minimal cost. Neither the private insurance nor medicare/medicaid reimburse the doctor for his or her use of the EMR and the patient is saddled with the cost.

I think that aurispector is suggesting the institution of health courts. The idea is that you have judges specially trained in health care issues who then retain objective outside experts to provide feedback and allow the judge to make a decision based on their findings. It's a lot more fair in getting money to more people injured from medical mistakes than the current system where the "jackpot" helps the lawyers than the patients.

What you might call a dictatorship I call a stabilization and modernization of Iran in face of growing Islamic and Communist groups working against the Shah and his policies. There are two sides to every story and it seems that you have clung onto one point of view and readily dismiss the positives outcomes that the Shah brought to Iran.

If I had to choose between a Shah run Iran vs that of an Islamic Republic, I would choose the Shah.

As a medical student, we are taught chemistry and biochemistry (not so much physics) including chemical kinetics in both our undergraduate training and in medical school. Your doctor either forgot the basics since he hasn't put them to use or is a dolt.

As one of the other posters mentioned, we get sporadic lectures on statistics and often it is in 60 minutes or less. Unfortunately, there are more important things that we need to concentrate on and stats just falls on the backburner of "things to do".

Nonetheless, statistics is useful to glean important information from medical journal articles and justifying whether a particular study is correct or incorrect in its assumptions and conclusions and by association how you can better treat and manage patients.