How far away are we from real-time continuous physiologic telemetry on all citizens of the western world with a worn device? Is this something that we want?
+1 to above. This is exactly my complaint. Lots of doctor-hate above which is weird, but look at the flip side, from a doctor who also does programming and studied CS. The EMRs are TERRIBLE. All of them. However, I don't rant about the incompetence of the IT programmers, because it is a gulf that we both need to address (physicians and IT designers).
I don't see this staying this way forever, but fixing usability issues are long overdue. In one Epic Fail system (those in the industry know what I mean), there is difficulty in even searching for a drug, you have to do old-style SQL type queries "starts with" or "contains", and spell rythmol as rhythmol and it can't figure it out. Obviously there are dangers to auto-correct with drug names, but finding the correct drug with a simple verification should be facile.
The UI designers also think that "clicking" is easier, but when you do something 100 times a day, as others have said, having full keyboard control is desired.
Finally, to load a patient or switch a context might take 20 seconds. Imagine that you have time-sensitive tasks and each time you do something there is 20 seconds of not-really-usable time wasted where you have to sit there and check the screen to see if it is updated? It is beyond frustration and doesn't work into the workflow of seeing patients.
Granted, I had the same complaints in 2005, and can't believe 11 years later I have the exact. same. complaints.
It said "Virgin could take on Tesla", so I thought it was about a fellow Slashdotter forming his own company.
Nothing at all. That is just the "PC Card" that is played whenever rude or abusive people don't like to be told they are acting like wanton children. It's their excuse to act as rude as they like for the sake of the attention it brings them.
Back when I was in college, the concept was known as Political Correctness, Multi-ethnic Cohesiveness, and Inclusiveness Actions, which people attempted to encourage in business settings. It got shortened to "PC Card" in the early 2000's.
There were insufficient bathroom breaks; European in the seat.
You two have a good understanding of the tradeoffs involved with decision-making. Unfortunately, many people do not and see suboptimal outcomes as "errors" in a very black-and-white world. I think the IOM report fed into many fears.
I am continuously annoyed about the IOM report -- as other posters have said, it is now out of date, and sensationalist IMO in the way it counted mistakes and deaths / errors. An "error" that had no effect in a critically ill patient who died 3 days later was counted as a fatal outcome. On the other hand, the sensationalism at the time might have been a bit warranted -- doctors are often very complacent and perhaps the attention was needed / desired to get large scale action. However, it had the side effect of the erosion in trust in those that work very hard, diligently, and conscientiously every day.
I very, very rarely use handwritten prescriptions. Certainly as inpatient (patients who are currently in the hospital) essentially all major medical systems have computer order entry as of 2012. In my outpatient clinic (people just coming for a doctor appointment) it is 100% computer medical scripts with automatic interaction and allergy checking. All of my hospital system is this way.
I can't remember ever having ANY medication or dosing error. Obviously I can't know about it if I don't catch it, but computer order entry, automatic checking, and the many layers of check from doctor, nurse practitioner, pharmacist, and nurse, (and patient!) does provide a safety net.
Can we do more? Well, banning handwritten prescriptions would be a pretty bad idea (if I'm in a community clinic wanting to give a patient some antibiotics for an ear infection, I think I should be allowed.) There are side effects to every initiative. Encouraging computer use is indeed being done, but limited by cost concerns.
The cupcake is a lie.
Very nice. A friend of mine just wrote an easy to use cloud app that does many of these steps automatically. Free yourself from GoDaddy!
This is simply not true.
If you are legitimately speeding (safely) to perform an urgent operation, the police may escort you to the hospital, enter with you, verify you are about to do an operation, then leave you without a ticket (it happened to several of my colleagues, usually late at night.)
Just being pulled over and showing your hospital badge / white coat is not going to help you 99+% of the time. *Especially* if you were driving in a dangerous fashion. One of my friends has a funny story on how he tried it after being pulled over, and his ID says:
The police officer laughed and gave him the maximum fine.
Totally agree with you. I'm a cardiologist, and this article just is full of alarmist oversimplification. Leaders in this industry are not complete idiots, and currently all of the connectors that they describe ARE incompatible (except, as you note, the intrathecal, as it is often essentially stock IV tubing, but ports are covered with a big warning / sticker.)
Making "special" tubing, as the article glosses over, may make the problem worse (e.g. situation:
Nurse: Quick, we need an IV in this patient in the ER, his pressure is low.
Tech: We don't have any IV tubing in this bay, but there is some black intrathecal tubing.
Nurse: Let's just use that for now (a tube is a tube) for the IV and change it later. It is an emergency.
5 minutes later, somebody comes along with spinal anesthetic, and now that it is "safe" with a color-coded tube, doesn't trace the tube to the insertion and just injects it into the patient.)
All safety legislation / efforts have consequences, and may not actually make people safer. Here, the situations described are *EXTREMELY RARE*, and frankly, likely due to negligence (I don't have exact details for each instance, but likely the person did not trace the tube, or jury-rigged incompatible connectors together.) Safety cabling may lead to a false sense of security, and current connectors are already incompatible. There is no shortcut or excuse for constant vigilance.
Probably a lot of books written on it -- Atul Gawande did a pretty big "study" with safety checklist prior to OR activation. We have several checklists (independent of anesthesia) before starting any invasive procedure, so this is kind of behind the times. It is more targeted at foreign hospitals or places that have a lot of mid-level providers that are not used to things. If you are interested, the full study can be found here:
>Says who? Citation Please?
[snip a bunch of rhetorical questions]
From your questions I infer you are completely out of touch with this field in any sort of form. If you want a citation, do a tad of research on your own and you will discover things; I won't spoon-feed.
Poke around here to start (but some of this might be biased the *other* way.) Do a good deal of academic reading and you will get a good feel of what is going on:
Again, ridiculously simplistic analysis.
>you should be excited every time you hear a doctor is being sued for malpractice.
You have got to be kidding; that statement is simply ludicrous. I don't engage in some sort of weird schadenfreude when somebody gets sued, even if it were somewhat legitimate. Medical school is relatively difficult to enter, selects for the most driven people, and is a long process where several dozen people work with you and gauge your progress and abilities. *OF COURSE* bad doctors need to be stopped, just like "bad pilots" or "bad computer programmers." Indeed, a lawsuit is one of many ways, in fact a poorly targeted way, of doing this. There are many other options including board registration, hospital credentialing, and outcomes monitoring. Life is not black and white.
The second paragraph of your post makes little sense. Can't have it both ways? Are you advocating ruining the career of good physicians in the hope of catching bad ones with a broad net? I am not advocating increased lawsuits, as the *vast majority* of them are groundless. That is not an opinion.
And yes, I am a doctor. You can check my long posting history for a bit of confirmation or at least support.
Ok, I'm responding to a troll, I know. But here goes. The post has a core of truth, but like all Slashdot-postings the "It's so simple I could just figure it out and do better" high-school naivety predominates.
>Doctors and surgeons routinely **** up on the most basic things, like which side of the body they're operating on, often in some VERY serious, permanent operations, like amputations.
- I have done thousands of operations and never a wrong-side operation. It is something that is taken *extremely* seriously, and we have at least three checks that guard against this. With over a billion procedures done per year, yes, there will be many that make the news, not unlike planes taking off on the wrong runway, etc., etc.
>Doctors and nurses, time and time again, have been shown to not practice the most simple procedures for infection control, like washing their hands before/after every patient.
- True again to a small degree, but everybody at my hospital does this. It probably could make a bit of difference if done nationwide, but again, this is taken extremely seriously.
>A couple of doctors in the Boston area have a)left patients on the operating table (opened up!) to run an errand at the bank b)shown up drunk or high for operations c)been beyond unprofessional to staff 'below' them (screaming, throwing things etc.)
- a) I was a resident at the very same major hospital when this happened. I know the inside story, and it was nowhere near as simple as it sounds.
- b) ?? The MD would be promptly fired. I don't understand what kind of life you imagine we lead.
- c) Yes, I agree this is a problem. This is a very big problem that the medical "culture" has some deficiency with. Equally bad is an antagonistic attitude by people "below" the MD who try to passive-aggressively sabotage things or "protect the patient" by alienating the rest of the staff. We need to work as a team, and at my hospital I strive to make sure that is always done.
> When the *** up, the malpractice covers the lawsuit.
Again, you have some sort of "fantasy" about M.D.s that is not remotely grounded. I'm guessing you wanted to go to med school and never had the wherewithal to go through with it? Or maybe had some unfortunate experiences as a patient?
- Nobody, NOBODY wants to get sued. The idea that we just sit in a lounge and make patients wait, etc., is pure nonsense. I work my a$$ off every day, and my friends with similar education and ethic get paid twice what I do. I am far from "among the most highly paid in society."
If you want a realistic sense of what may go on during a suit, read this piece:
A man is known by the company he organizes. -- Ambrose Bierce