Something my doctor friends remind me of from time to time is how disconnected their actual workflows are from whatever system the money folks decided to buy.
People making the purchases are not the ones using the system and they hate it because it doesn't serve them... A tale as old as time.
For example, one of my doctor friends mentioned he has to scroll past an "order birthday cake button" at the top menu level so he can get to the order tests section and drill down to actually order tests.
This is a symptom of a deeper problem in medicine, the subjugation of doctors. It used to be that doctors ran their own practices and were the Götter in Weiß, the gods in white lab-coats. What they said was what happened, and healing patients was their purpose. Now, however, doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. If computer workflows are optimized for the suits rather than the doctors, that’s a symptom of a problem whose other symptoms, like rampant price inflation, are yet worse.
My company builds software for medical office assistants, and our clients are typically doctor-owned clinics. We have literally the same problem, but one step down the ladder. The doctors are making the purchasing decision, but MOAs are the direct users. And ironically enough, we have often run into the same problem. Doctors often don’t see the value in software that solves their subordinates’ problems.
>"Doctors often don’t see the value in software that solves their subordinates’ problems."
This was such a huge problem at my former company, Billit (getbillit.com), that our number 1 method on achieving clients was making such steep referral incentives for doctors, to their colleagues. We only needed one to make scale eventually happen, but the organic clients couldn't empathize with the workflows of their front desk - they didn't care.
Indeed, and something else many people don't know is that a lot of (mid to senior) doctors have ownership stake in the hospitals, or are part-owners of the building that the hospital leases, etc. So it's not a direct "owernship" relationship anymore, it's more like a stockholder who works (contracts) for the company, sometimes with a hop or two in the way. I'm not saying this is good or bad (it doesn't seem at all clear cut either way to me), but it is something I found really interesting
I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.
You are not mistaken. Contrary to the conspiracy theories you see on here about the AMA, lately they have been lobbying Congress to increase funding for residency programs because that is the primary bottleneck to producing new physicians.
So after studying for a decade a soon-to-be physician needs to go through a government funded job in order to qualify as a physician?
Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
Anyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies.
If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.
> Most residents generate less revenue than they cost to train.
Is this just a thresholding issue? What substantially changes about the resident from year 1 to 3? Can you chop residency up into different tiers where they don't need somebody watching them do stitches once they're no longer the lowest tier?
I find it extremely suspicious that a sector with so much money in it can't figure out how to make apprenticeships profitable but an electrician can.
You seem to be confusing amount of money with actual control. Electrical contractors can charge any price they want (subject to customer demand). Hospitals, especially teaching hospitals, have no such freedom. Medicare reimbursement rates are fixed by government fiat. This is not a free market.
Residencies are already chopped up into tiers. Those with more experience have more clinical and administrative autonomy. But for the most part, Medicare doesn't allow hospitals to directly bill for work done by residents. With a few limited exceptions, all of their work has to be supervised and signed off by a qualified attending physician. This training and supervision is extremely expensive.
Any major reforms will have to come at the federal government policy level. This is not a problem that medical schools and teaching hospitals can solve by themselves.
I think it is primarily a matter of insurance expectations and regulation of residents. It dictates what services they can bill for and the amount of redundant oversight required.
The problem is largely imposed by Congress in terms of strict rules about what hospitals are allowed to bill Medicare for. This is not something that teaching hospitals have imposed on themselves.
> 2024 Median Pay This wage is equal to or greater than $239,200 per year or $115.00 per hour.
> Physicians and surgeons typically need a bachelor’s degree as well as a medical degree, which takes an additional 4 years to complete. Depending on their specialty, they also need 3 to 9 years in internship and residency programs. Subspecialization includes additional training in a fellowship of 1 to 3 years.
So on ~240k you pay ~50k takes just to the federal government and we'll say 12k to the state. 178k is still pretty good, knock out 80k for living expenses (better not live on the coasts) and you're left with 90k which would (naively) pay down 300k debt in 4 years. That said, you're also probably 30 with a net worth of 0$ and could've done a different career path to make ~240k per year without a decade of education.
Hahahahahaha 4 years to pay off education for the most lucrative profession in the US. (And you assumed 80k/yr for living expenses... whats the median income in the US? 50-60k? hahahahaha)
It's really easy to paint this in a negative light. You can go study for an extra decade to be a doctor to make as much money as not studying for a decade and working in fang. Becoming a doctor over many over professions puts you literally millions of dollars behind. Doctors are not the most lucrative profession.
You're really missing the point. There is a huge variance in physician wages based on specialty and location, to the extent that looking at averages is mostly meaningless. We already have a growing shortage of physicians, especially primary care providers in rural areas. Asking prospective doctors to fund their own residency slots will only make that problem worse.
>Asking prospective doctors to fund their own residency slots will only make that problem worse.
Its literally the opposite.
If you have them fund their own spots, there would be potentially unlimited spots.
The limit is caused by the boogeyman of not getting government funding, not that people can't afford the temporary debt.
There was some stat that 1 in 4 qualified people become doctors. The problem is not supply. The problem is the cartel legally reducing supply to prop up wages.
> Now, however, doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine.
Just one more way that private equity ruins the world.
I always like this when explaining why the A in the CIA Triad matters: The most secure computer is one powered off, encased in cement, and dropped into the middle of the Pacific Ocean. But it's not very useful
But it's not just about money, its about compliance too. If you can tell a higher-up "Use my software and you'll never have to worry about another compliance issue" that's also pretty appealing regardless of how well it fits the current workflow.
> Something my doctor friends remind me of from time to time is how disconnected their actual workflows are from whatever system the money folks decided to buy.
There are two ways EMRs get made. They start from the money side and grow into clinical, or they start in clinical and grow into finance. This means however they started, that's what it'll be strong in.
I would absolutely love to get to help design an EMR. A huge part of my job is finding ways to help our clinical staff spend less time in the EMR and more with patients. There's so much room for improvement, but it's a hard market to crack.
You are absolutely correct about it being a hard market to crack.
My wife, who is a doctor, often complains that the various systems she has to deal with are often unusable.
When I was designing my new, general-purpose data management system that handles both structured and unstructured data well; she begged me to try to come up with a better system to manage medical data.
While I think my system has the potential to make a much better EMR; the work and money needed to break into that market felt beyond my reach.
A little startup with a superior architecture, but without all the political influence and domain knowledge to navigate the medical world; has little chance of gaining a foothold.
Also known as the Blackboard problem... It has to be the worst software I ever had the misfortune of using, because the people who choose it (admins) are not the ones who have to use it (profs and students.
Also quite telling that when you go to Blackboard's (now called Anthology, apparently) site, 75% of it is dedicated solely to AI.
You get a small blurb about "Experiencing the power of Together™", whatever that could mean, some small product description, of course all "AI-enhanced" and then lots of fluff about "industry-leading AI capabilities", "responsible/ethical edtech AI", "AI roadshows", etc.
So much ado about what's definitely just an annoying ChatGPT wrapper button that most will definitely quietly learn to ignore... :)
It's a multimillion dollar business entirely dedicated to the enterprise of selling Blackboard to schools. With the side-effect of producing a terrible piece of software.
2. You're improving the metrics of the people who put it there.
A better strategy would be to call the support desk stating that you can't find the order tests section. Then when they tell you where it is, state that you assumed you were in the wrong menu due to the presence of the obviously unrelated order cake button.
You may be pleased to know that you can do this via the GDS system for meal preference when booking flights by using the code CLML ("celebration cake meal") if your travel agent is cool.
I know the best doctor you'd ever have the privilege of being treated by. He's smart, kind, knowledgeable, experienced, and has a gift for noticing things others miss. I'd meet other doctors that knew him and they'd say he's the kind of doc they'd want treating their mothers.
He has never been great with computers (though he often reminds me that he successfully created a boot disk with virtual RAM to run Falcon 3.0 on my IIGS when I was a kid). He's not totally incapable of using modern tech, but I am his tech support and we still occasionally deal with basic stuff like how to forward in gmail or save a PDF on his phone.
I remember when his hospital switched to EMR. It was a nightmare for the first six months, but he eventually got the hang of it. Some of the other older docs requested assistants to help them but he was stubborn and prefers self reliance if he can help it and just gutted though it.
That was years ago and I far as I can tell the doctors in his circle are very used to EMR now. I hear some are even liking new AI features that listen to an appointment and automatically draft notes (that the doc obviously must review and sign off on).
My dad retired this summer after more than 40 years of 60-80 hour weeks saving and improving countless lives. He still struggles with computers, but I don't know much about medicine so it's more than a fair trade of advice for me.
I’ve been looking for a good doctor for a while. I’m assuming that you were talking about your father, but if you know anyone you’d recommend (in US) I’d be very thankful.
That ship has sailed. And that isn’t the only use of AI in medicine. Radiology gets AI generated referrals that the referrer (apparently) reads before sending.
The MR images has signal added by AI in k-space. Then the frequency domain data is transformed to images and AI doubles the resolution (Thanks Siemens deep resolve). Then PACS checks for various things depending on what radiology paid for (stroke, lung lesions, fractures, breast lesions).
The report goes out, ready for your follow up appointment.
At my last doctor's appointment the nurse asked if I was okay with AI conversation transcription and summarizing that the doctor uses. So I had the option to decline.
I'm not sure how I feel about it yet. There are contextual details you might include when talking to your doctor that you wouldn't expect your doctor to write down into your medical record.
There are hordes of startups working in that space, generally using HIPAA-compliant cloud services and/or on-device models, with different startups focusing on different specializations.
I would count them among the most viable startups in the AI space (implementation-wise), and also among some of the most necessary with the aging population. They are also compared to other places where AI is trying to be employed in the healthcare sector on the "lower risk" side of things (doctors still are accountable, and the benchmark are the current badly hand-typed notes).
Oh so the recording is being sent to a compliant service. That’s okay then. I’m sure all these doctors practices with their creaky dusty monitor mounted windows 10 thinkstations absolutely can’t be hacked or that the data could never fall into the hands of the government or anyone else.
So you are objecting to general electronic processing of healthcare records then?
Not sure how that is realistic in a world where insurance exists, unless your ideal is paper documentation and paying privately for your treatments in fiat. If that is what your after, I guess we've already been in a "over your dead body" world for decades.
I doubt if they're using raw MS or Open AI models (because the whole thing would have to be HIPAA compliant) but yes, some doctors will now ask if you consent to them using AI tools to transcribe the appointment.
Honestly, what’s the big deal? Before it was ai transcription they still used transcription a lot it was just algorithmic.
If your concerns are about privacy, that’s a seperate issue regardless, whether it’s AI or not doesn’t mean the data is being shared or not, and same with the transcriptions from before.
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.
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.
Dentistry has changed in the last decades. If a dentist refuses to use useful computer things, I instantly wonder if they are also out of date with modern best practices. Better materials for infills and stuff like that.
I'm in the process of having some dental implants done and the process is amazingly high tech - I was particularly impressed at the 3D model they created from CAT scans that they then use to position instruments during work - they attach something to my teeth to tell where my head is and the software guides where the instruments should go based on 3d sensors.
Wouldn't surprise me if they went fully robotic for some things in the not too distant future.
I've been with my dentist for a while and in the last 10 years or so I think they've updated their X-ray machines twice. It used to be a massive machine that was in a special room, which they'd use to take multiple photos of your face by wheeling around. Then they got a smaller one that could be right next to your chair, and they'd make you bite down on some film while they moved an arm around with the source on it. Recently they have a new machine that you put your head in and it just seems to do the whole thing in one pass.
The head thing might not be doing the same x-ray as the bite thing.
I'm impressed they only got the bedside one recently. My dentist just recently upgraded to direct digital sensors for their x-rays (wires to the computer in the room instead of digital plates), but the X-ray source shows decades of battle scars.
I did ask a dentist once about why the roots of my wisdom teeth were so strangely distorted in an X-ray and they carefully explained that there was no distortion and they really were that shape...
My mother is a dentist on the verge of retirement who used to fly to conferences all the time and ran a reasonably successful dental practice with about a dozen employees (and plenty of computers). She would always talk about how the new implant ceramics are not as durable as the old amalgam and they're only popular because they're white instead of gray.
If you're in the US this might be for a specific reason.
If you're a medical facility that isn't digitized then you're not subject to many of the HIPAA privacy and security compliance rules. It's an exception they carved out to grandfather in older practices that weren't digitized.
Many facilities stay "analog" in that way for that explicit reason.
Source: used to be a certified HIPAA Security Officer, this was a topic at the certification seminar I attended.
Then again, paper can't leak as easily as a database
Are the security requirements of HIPAA good? (genuinely wondering: your data goes to tons of organizations, any of them could use a not properly secured database and leak it. And are the requirements good both in the technology and practices, as who's accountable?)
Any data processing by a third party must be done under a Business Associate Agreement (BAA), which transfers responsibility under HIPAA with the same rules and regulations to the third party. There's always a chain of liability when processing PII, traceable back to the PCP (primary care provider).
The regulations also leave things open ended in terms of specific ciphers etc, stating "industry standard" encryption at rest and in motion (i.e. transport security) must be used, for whatever definition of industry standard is correct.
As for privacy, exfil of PII even in non-digitized establishments is still covered (hence why there is typically also a Privacy Officer appointed with a HIPAA complaint org, distinct from a Security Officer, both being actual terms and certifications being handed out by certification bodies). That covers general privacy and a much larger scope, and applies to any healthcare establishment - not just those who use computers.
Cryptographic audit trail requirements, third party audits and reviews, a slew of other software certifications (some even from the government, such as Meaningful Use), etc all exist to help with that mission.
As for who's accountable, it's always tied to the processor of the information, and "breaches", which are violations of either privacy or security policy, must be reported all the way back up the chain in a timely matter, and in the event the breach might cause risk of harm or disclosure, must also be reported to a regulatory body (I forget which), in which case the offending party must pay a fine. There's insurance for these scenarios, I forgot if it's compulsory. But it racks up fast, and IIRC you're liable in most cases for damages up to a ceiling, somewhere in the 9 figure range.
What's more is that there's also Qui Tam lawsuits which, as I understand things, can be brought against an offending healthcare establishment by a whistleblower of sorts (i.e. a third party who observes a breach, without being part of the chain of responsibility (the healthcare establishment) nor affected by the breach) on behalf of individuals harmed by said breach. As far as I know, anyone can do this.
IMO, for what it tries to do, I think it does an okay job. It's a really difficult thing to generalize and standardize given not only the flux of technology but also the fact that you still want independent innovation in the space without regulatory overreach.
(This is a massive oversimplification of my slightly outdated knowledge of this as I've been out of the US healthcare field for a while now)
A relative of mine had to go back to their paper-only specialist a couple of months ago to get a prescription reissued because the specialist had omitted a mandatory detail from the (handwritten) prescription form and the pharmacist couldn't fill it.
Meanwhile, I had a similar prescription, from a different specialist, who issues his prescriptions as either e-scripts or computer-generated paper scripts depending on patient preference. I suspect his practice management software would stop him from making this class of mistake entirely.
I get why a doctor might prefer to avoid the computer, but I think my relative would have preferred their doctor not screwing up on something basic and wasting a significant amount of their time over better vibes in a consult.
Ive had so many problems woth e prescribe. Half the time its "just not working right now" the other half they send to the wrong place, or they send to a pharmacy that doesnt have supply and you cant find out that theyre out of stock until they recieve the script. At which point you have to cancel and then contact your doctor to resend. Which can take several days. Whereas with paper prescriptions you just drive to the next pharmamcy.
Why would that necessarily be the case? I understand that bad software can get in the way of anything, but I find it hard to imagine there is nothing out there that actually helps any given (and willing) physician to improve their work, and make more time for patients, not less. There are inherent properties to IT that can help make stuff more efficient across any domain I can think of, and physicians work checks a lot of the marks.
I happen to work in the medical field and while a lot of the software involved has its issues, not working with software, at this point, seems like a really bad idea, in terms of error prevention, performance and efficiency.
I'm a physician. To understand why this is true you have to understand that the software is not intended to the make the physicians jobs easier or more efficient. The point of modern EMR's is to take every patient encounter and generate a list of billable codes that maps onto the encounter in such a way that insurance companies are less likely to send it back. The stuff like checking medication interactions is just tacked on as an afterthought. Through this lens everything else makes more sense.
Paper-shuffling used to be not a major issue in a doctor's work day. It was merely something that yes, sure you had to log new patient data and whatnot for reference, but you were mostly free to do the paperwork in a way that fit your natural workflow. Based on the doctors I know/knew, it was not a pain point. Yeah, you would sometimes have to fetch physical papers from somewhere instead of clicking yourself to the same information on the computer, but that was not a major issue. I'd say it was similar to a programmer who's waiting for an incremental compilation to finish: a minor moment out of actual work but nothing to fret about.
After doctors' offices got digital then interacting with the computer specifically certainly became an issue which didn't exist before. At best, it was just a clumsy way to do the inevitable and at worst it became a major part of the patient visit, with myriad of odd tricks you had to learn about some particular computer software in order to accomplish your actual goals.
If something that used to be normal part of work nobody thought twice about once become noted as a separate issue of the work day, something did change there. Sure, there are benefits too, but it's the friction points that you feel at work when you're trying to get other things done. Sure, software could be written to serve the user and not the other way around, but software rarely is -- no matter the profession, doctors aren't the only ones!
My old family doctor used to have IBM terminals into the early 2010s, I'm fairly sure there was an AS/400 somewhere in the back rooms where all the serial lines in their practice converged. Very fast system. Meanwhile I was at a specialist some time ago and they had to switch back and forth between notepad and the medical app, because you can't enter more than a few words at once into the app. So he would write everything that's not a drop-down in notepad then copy-paste it.
Well for one thing it's much less likely for someone to steal 36000 therapy files and extort people into suicide when they're stored decentrally on paper in locked cabinets instead of ~~the cloud~~.
This has nothing to do with "knowing how to use a computer."
Looking at a screen while you check through dozens of flags and billing related documentation instead of looking at the patient is much less personable.
I can see that working today in dentistry more so than general practice. I’ve got medication that insurance has dictated that I need to refill a weekly med monthly and it arrives precisely the week I need to take it. I need to time my vacations around this med now.
I get that I’m ranting against healthcare and not doctors, but I’d run far from any doctor that’s paper only these days.
I disagree. It’s wasteful spending your day trying to read doctors hand writing. There are dozens of other issues that come from technical incompetence, but the handwriting one alone is a vast waste of time and money.
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.
It's not just filing the X-rays. Back in the day, for a big crown you got yourself a full mouth cast, ship it away, and eventually you got a crown which hopefully fit. Today you get a much less invasive scan before the root canal. one after, and the 3d printer in the back creates a crown that fits. Much faster, cheaper and typically even more accurate.
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.
Dental software is terrible as far as I can tell. I’m at school /practice were the staff cheered loudly when it was announced they were planning to upgrade or change vendors.
> 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.
They stopped the improvement around Win 10. Since then, everybody (Microsoft, linux, Apple - Google never had a wheel) is reinventing a worse wheel, regularly.
Eh...I'm all in for doctors who can actually take emails than just phones. I fucking hate talking over phones. I don't need "family" doctor. I need a family "doctor".
HIPAA doesn’t exactly make that illegal, but it comes so close that approximately zero doctors would be willing to skirt that line and risk the enormous penalties if they guess wrong.
Me(2010 ish): Hey can I get my x-ray pictures before I leave?
Doc: No, there's no way to get pictures off of this computer
I had the pictures saved on a flash drive about 30 seconds after he left the room. They were using some awkward browser-based system where everything was served as an html page. It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.Just a personal anecdote.
> It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.
That doesn't surprise me, for the same reason I can't tell you what a metatarsal is without googling.
What did surprise me, was that my dad had a home PC with internet for years before realising that Google search results had a scroll bar — it's not like he didn't know how computers worked, before retirement he'd been working as a software developer for one of the big UK defence contractors.
Can't comment on Google specifically but hidden scrollbars mean I often don't realize a dialog has scroll bars until I reach out into the dark edges to find what I hope is there. Microsoft will even harness this as a dark pattern to hide options they don't want you to choose.
Perhaps your dad simply expected to scrollbars to be visible like they initially were.
Metatarsals don't come up in your daily work. Using a computer is a constant daily task for a doctor. In this example he failed to use it properly and just said it didn't work instead. That's not really OK.
Almost certainly saving the image was a violation of hipaa policy— giving emr records without the proper logging/etc can get the doc fired. The patient had a right to their images, but it’s like anything enterprise, getting it has to go through the proper channels.
You can probably imagine the privacy problems if that image were saved out of the cache directory.
I don’t think criticizing doctors for not knowing you can right click save image as makes any sense because it’s not an important part of their work.
Imho, the first thing doctors need to learn (at least in my country) is to touch type. I've had it with 5 min exams followed by 15 minutes of pecking to type in the necessary forms. Multiply by number of patients in a day and it adds up, and it's prevalent, family doctors, dentists, specialists, nobody bothers to learn it. Gets tiresome when you know you're in the waiting room for a couple of hours because they are slow at typing.
I used to do support for a service that did transcription for doctors. The doctors would call in and tell the medical transcriptionist what to type and they would do the input.
It always seemed incredibly inefficient and expensive but hospital management told me this was the most dependable way to get accurate records and even a single lost lawsuit would cost more than the service.
And by the way, when I was a child, even before the computers came, here is how it worked in Russia.
The doctor was listening to my breathing, looking at the throat, asking me and my mother questions, and saying various medical phrases to her assistant, who was then writing them into my patient records (a thick paper notebook).
I think this is one of the use cases where speech-to-text and (AI) transcription tools would be useful. Of course ideally there'd be two people, one doing the medical stuff and the other then documentation, but health care is expensive enough as it is.
Medical scribes are a thing. Some provider organizations employee people who attend patient encounters and do all the EHR data entry in order to free up clinicians for higher value work. This generally works well, but it is expensive and payers don't directly reimburse for that service.
It turns out that peach to text is slower than dictating and having a typist type.
The speed at which reports are dictated is incredible and even when familiar with the field it’s hard to understand how the typists are getting it right.
What we need is a universal standard way to store all of our personal data on our phone and share whatever is relevant at whatever company/government at the touch of a button.
Nor a secretary nor a doctor nor anybody should have to hand-type data that already exists digitally.
I'm so mind-blown that this doesn't exist yet that I feel maybe I should try and build it. I have tried building the next-best thing: OCR based form filling, but hard to get far as a solo FOSS'er.
We have a national health database in Finland called "OmaKanta" (which translates to MyDatabase or something like that). It's not perfect but at least I can trust it with most of my health records, and it's accessible to all doctors working in both public and private sector.
Many healthcare provider organizations have standard HL7 FHIR APIs that patients can use to download their own chart records. There are a variety of apps that you can use to call those APIs.
Sure, let’s send private medical data to a cloud server somewhere for processing, because a medical professional in 2025 can’t be expected to know how to use a keyboard. That’s absurd.
I can type quite well. I can also troubleshoot minor IT issues. Neither is a better use of my time than seeing patients.
I’m in an unusual situation as an anesthesiologist; I don’t have a clinic to worry about, so my rate-limiting factor isn’t me, it’s the surgeon. EMR is extremely helpful for me because 90% of my preop workup is based on documentation, and EMR not only makes that easy but lets me do it while I still have the previous patient under anesthesia. I actually need to talk to 95% of patients for about 30 seconds, no more.
But my wife is primarily a thinking rather than doing doctor, and while she can type well, why in the hell do we want doctors being typists for dictation of their exams? Yes, back in the old days, doctors did it by hand, but they also wrote things like “exam normal” for a well-baby visit. You can’t get paid for that today; you have to generate a couple of paragraphs that say “exam normal”.
Incidentally, as for cloud service, if your hospital uses Epic, your patients’ info is already shared, so security is already out of your hands.
This has been happening for years, long pre-dating LLMs or the current AI hype. There are a huge number of companies in the medical transcription space.
Some are software companies that ingest data to the cloud as you say. Some are remote/phone transcription services, which pass voice data to humans to transcribe it. Those humans then store it in the cloud when it is returned to a doctor's office. Some are EMR-integrated transcription services which are either cloud-based with the rest of the EMR or, for on-premise EMRs, ship data to/from the cloud for transcription.
Macs have pretty decent on-device transcription these days. That’s what I set up for my wife and her practice’s owner for dictation because a whole lot of privacy issues disappear with that setup.
The absurdity is that doctors have to enter a metric shit ton of information after every single visit even when there’s no clearly compelling need for it for simple office visits beyond “insurance and/or Medicare” requires it. If you’re being seen for the first time because of chest pain, sure. If you’re returning for a follow up for a laceration you had sewn closed, “patient is in similar condition as last time, but the wound has healed and left a small scar” would be medically sufficient. Alas, no, the doctor still has to dictate “Crime and Punishment” to get paid.
Medical companies could self host their speech to text translation. At the end the medical data is also on some servers stored. So doing speech -> text translation seems just efficient and not too much worrying if done properly.
So you think the better solution to doctors not being able to try is for them to self-host a speech to text translation systems, rather than teaching doctors to type faster?
Their healthcare/IT provider like Epic would do it. And in fact some have already done it, from what I can see.
Furthermore, preparing/capturing docs is just one type of task specialization and isn’t that crazy: stenographers in courtrooms or historically secretaries taking dictation come to mind. Should we throw away an otherwise perfectly good doctor just for typing skills?
Who is responsible when the speech-to-text model (which often works well, but isn’t trained on the thousands of similar-sounding drug names) prescribes Klonopin instead of Clonidine and the patient ends up in a coma?
This isn't a speech recognition problem per se. The attending physician is legally accountable regardless of who does the transcription. Human transcriptionists also make mistakes. That's why physicians are required to sign the report before it becomes a final part of the patient chart.
In a lot of provider organizations, certain doctors are chronically late about reviewing and signing their reports. This slows down the revenue cycle because bills can't be sent out without final documentation so the administrative staff have to nag the doctors to clear their backlogs.
I imagine where the speech to text listens to the final diagnosis (or even the consultation) and summarizes everything in a PDF. Of course privacy aware (maybe some local hosted form).
And then the doctors double checks and signs everything.
I feel like, often you go to the doctor an 80% of the time they stare at the screen and type something. If this could get automated and more time is spent on the patient, great!
Sure did! I think you're vastly overestimating the security of... basically everything computer related in the 2010 and earlier era.
I did not poke around obviously, because I was only interested in my personal files and assumed I only had a few minutes. Could I have been 'evil' and accessed other stuff maliciously? Maybe idk.
Years before I also had root access to my entire school district's records and probably could have wiped them if I really wanted to. I'm not a hacker or programmer by any means, just a random idiot that figured out how to use ophcrack back when XP was the primary operating system. It was a different time.
I'm mostly just surprised that the doctor didn't lock the workstation when they left the room. Especially if it was a radiology workstation (rather than e.g. exam room EMR workstations); the sensitive data risk from leaving it unlocked is huge!
Like, I'm not saying that'd solve computer security or anything, someone could still break into a locked computer. But it would definitely raise the level of effort required to access medical data up from "has a flash drive and five minutes".
I'm sure doctors get the same lock-your-workstation trainings as the rest of us, and ignore them about as often. I wonder if smartcards would be appropriate here: since doctors are typically jumping between lots of "thin-client equivalent" computers around their practice all day, could we give them smartcards that need to be physically inserted in computers in order to log in? Pull the card, computer logs you out; don't forget your card in the exam room or you can't log into the next one.
Like, I'm sure they'd have tantrums (any kind of users would, at this transition), but putting that aside: this kind of system is technically cheap and has been well-supported for decades. Would the overhead of employing it at medical practices be preventative? Is it already employed at some practices? How does it work there?
> I think you're vastly overestimating the security of... basically everything computer related in the 2010 and earlier era.
My astonishment is unrelated to IT security. Your behavior is equivalent to just sneaking into the unlocked office of your doctor and taking photos of your file.
Well what's the alternative? Get in a week long battle with the hospital while they struggle to locate and send a 500kb jpg? I AM talking about the American healthcare system here.
Yeah, I'll just grab it myself. It was a standing workstation right in front of the exam table and he didn't even close the browser. Would have taken 3 seconds to lock and unlock if they cared about security.
My experience as well, in a hospital a doc left me with sa fully logged in console, to feed my kid in his office (which is incredibly kind of course). I for one got that "walk afk = alt-f4" rammed into me at my work place at that time. Makes me think that there might be a face-id like unlock (and immediately lock) market out there for PCs...
I expanded on this in an adjacent comment: smartcards might be a cheap and easy solve here. Insert the card to log in, pull the card and you get logged out. Bonus points if the smartcard is also your access card for e.g. the break room.
Albeit whatever others said, I think it's PERFECTLY fine that you did that just for your own record. I'm not being cynical. Getting my own medical records is far from easy and I don't give a fuck anymore.
Will I do it? Probably not. But I salute all who does.
I wish people had basic computer skills too but I think it's a failure of software design if you expect a random working professional to know how to work around the lack of obvious functionality?
This points to a wider misconception that the public has. Computer engineers learn how to build computer systems, they don't learn how to use computer systems. Automotive engineers are not necessarily good drivers either, and an architect can get lost in your building just as well as anyone.
Sure you get a lot of it through osmosis by spending a lot of time at the computer, but computer science professors struggle with projecting slides from the in-class computer just as much as high-school teachers.
My point is that, sure, it's reasonable to expect a doctor to know absolutely nothing about programming. But if using computers is such a central aspect to their job, it's not unreasonable to expect that they will be proficient in operating medical computer systems, probably better than computer engineers.
I'm not talking about programming. I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions, even those that are arguably more important.
Do you have basic knowledge of your own body? Anatomy, for instance? I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Or how many people who drive know what a catalytic converter is, or what symptoms are typical of it failing? Or even what to do when certain idiot lights light up on their dashboard? The check engine light comes on, do you stop on the side of the road or can you continue to your destination? Or can you continue, but just to a garage? Do you have to do so at reduced speed? How about if the oil light comes on? How about if the low tire pressure light comes on? How about if the airbag light comes on? How about if the battery light comes on? How about if the light with an exclamation mark inside a triangle comes on? How about the light that looks like a profile of the car with skid marks under it? How about the light with the cryptic three letters ABS?
> I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions
That was their point: keyboard, mouse, and basic computer interaction is general knowledge that anyone in modern life should have, like first aid or what traffic signals mean (for both vehicles and pedestrians).
Yes, and the doctor in question is skilled enough to use them. He uses them via hunt and peck, not touch typing, but that's good enough for his purpose.
> I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions, even those that are arguably more important.
I'm a bit confused about what you are saying. Basic use of a keyboard and mouse is not exclusively part of the software engineering or IT profession. It is in fact part of every job where as part of your job you use a computer. Which is almost every job nowadays.
Same as writers are not the only people who are taught how to write, and accountants are not the only people who are taught arithmetics.
> I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Sorry to hear that, and I hope you are feeling better. Not really sure though what is your point. Are you saying doctors should not know about basic use of a keyboard and mouse because you haven't heard of the rotator cuff? Or are you saying that people should be also taught about the rotator cuff who are not doctors? I just don't really understand your point.
> Or how many people who drive know what a catalytic converter is, [...] How about the light with the cryptic three letters ABS?
Come now. You mean to tell me the same doctor doesn't use a computer at home, write emails, make an occasional document or spreadsheet for tax purposes, doesn't carry a smartphone in his pocket, text other people?
A doctor is a human being, not a specialized insect.
I know basic things like cpr, how and where to apply pressure to stop bleeding, signs of a stroke or hypothermia, you know, basic vital stuff to keep someone alive in case of emergency.
Similarly, I'd expect a doctor to be familiar with things such as "save as" or "print screen" if they used a computer every day.
I work as a software engineer and a manager in a medical devices company, but also as a hobby, whenever I'm at the doctors, I always ask them to show me the systems they're using.
A few observations:
* software for medical devices is obscure, usually still done with 90s/00s technologies, people in the field are underpayed too. The result is you get bad code and most of the time you're just maintain it, instead of implementing new stuff,
* this applies to both software and hardware - amount of often useless paperwork is ridiculous. You're bound by a lot of standards and regulations to make software/hardware compatible with those regulations. Which means engineering is not doing much engineering, but rather fillout those docs, do countless reviews of them, spend a lot of time on testing and QA. I know a few of those standards by heart, and often the work is not about implementing a standard but rather about being complaint with the standard - aka interpreting and stretching them that whatever you do is kinda complaint, but not really following the rules
* software to manage these docs/requirements is also from 00s/90s, super not intuitive
* med software itself, like stuff used by a doctor or folks in a hospital has really terrible user experience, sometimes it takes years to master it. Then once people master it, they get used to it, they don't like upgrades, cause then you have to master them again,
* in my country you can do a lot of med stuff via email, what they call "encrypted email" - it's not PGP, and it's not encrypted with x509 certs etc You get like an email with a page embedded there that only works on Edge or Chrome, and to "unencrypt it" you need to put like data of birth or something like that.
This market seems really miserable from software/firmware perspective. Happy to ask some more questions.
Famous physician Dr. Abraham Verghese was telling in the freakanomics radio podcast that doctors now a days are behavinv like software professionals by being on their computers and ipads instead of touch the patient and looking for well-known symptoms physically like how doctors used to do.
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.
The electronic system often benefits complex patients more than someone like you. All your relevant history could fit on a few pages.
But if you have many illnesses, medications, and unclear causes - then having all the data documented and available to different doctors you may see is helpful.
As a doctor, I often get asked when I'm going to be replaced by AI, or if AI can help in my work.
The reality is that our work efficiency could have been made so much efficient with a bit of decent user-friendly software that is optimised for the user.
I also love computers and IT, but as a result I understand highly-optimised (usually open source) software.
The proprietary system we have at work is a mess. Inconsistent widgets, some keyboard shortcuts for some dialog boxes, but not for others. Lots of forms that need filling that I shouldn't be having to fill out (it's the same every time but I have to go through the whole process just to speak to a patient over phone).
As others have mentioned here, senior doctors used to look at the patient, and give their opinion. Admin and junior doctors would turn it into action in a safe way, following protocol and prescribing advice to make it happen.
These days senior doctors are checking in their patients themselves, clicking through many menus to order blood tests, checking out their patients, writing their patient letters, and basically sorting out the majority of the admin for enacting what they recommended should happen.
Corporations also set up stuff in rather hostile ways.
I just spent 30 mins searching for the option to create a simple support ticket saying computer hardware on desk X broken.
It’s just layers upon layers of AI agents, help articles, automated systems, voice recognition etc to make it as hard as possible to actually get help from a human
Ha, my whole life. I am a doctor with a CS degree.
There is a fundamental neurological difference and deep mental incompatibility in the "technical" and "medical" way of thinking. You can NEVER be good in both simultaneously.
When I am with and think about patients, I cannot use a PC (in the where-is-the-poweron-button way) and when I maintain my little Github projects, I become a dangerous doctor. My ability to change my brain with an "internal mental switch" has improved dramatically, it happens even in minutes.
A great share of my income as a doctor comes from filling medical reports on various online platforms, covering 100000 people which my other five colleagues cannot serve. The platforms are not complex, just online forms that have a lot of copy-pasting and a bunch of clicks and up-downloads. The texts are so similar that I might try to automate/-fill them, most probably with a addon. I imagine they seem awful and scary to them and I don't blame them because it is painful to write a digital medical report and do anything else except... writing.
I mostly choose being in the medical state of mind because there are emergencies I must confront. I do not serve any online project that would need immediate technical intervention
-:) <== I am doctor, how do you create a smiling face?
> Indeed, the computer, by virtue of its brittle nature, seems to require that it come first. Brittleness is the inability of a system to cope with surprises, and, as we apply computers to situations that are ever more interconnected and layered, our systems are confounded by ever more surprises. By contrast, the systems theorist David Woods notes, human beings are designed to handle surprises. We’re resilient; we evolved to handle the shifting variety of a world where events routinely fall outside the boundaries of expectation. As a result, it’s the people inside organizations, not the machines, who must improvise in the face of unanticipated events.
In this new age of AI, maybe we can start to reverse this trend? Make systems that can adapt and handle surprises, instead of pushing all this brittleness onto the humans using the system
I bet it would be fine if they stuck to Windows 3.1 and MS Word 6, or DOS + Wordperfect 5.1 (with no network connectivity) which was approximately what I used for my homework.
The problem isn't "computers", its the internet, and ads, and the fact that all "modern" stuff is just a thin wrapper around that.
I wish they were actively taught how to stay on task instead of being shamed into it.
I mean they're being handed over / bring their own computer / have their phone at hand, and anyway they probably have all of that at home, and will have at work someday.
From that state of affair the best thing to do is to try and give then the tools to best manage and navigate the situation, not yell "stay on task" at them (which is AFAIK basically the only course of action) which is wholly unproductive.
I have been working at Kaiser Permanente for 5 years, and there were a lot of doctors pretty good with technologies. And they struggle with Epic, famous for bad UX as well. One doctor even created special windows application, where they recorded mouse/keyboard activity with Epic, and replay them on single button click. Same as anthropic "Computer Use", but in the traditional code. And it was written by doctor, not IT engineer.
Later, I worked at startup that tried to create intelligent hospital bed, able to record patient heartbeat, respiration, movements without special sensors. The technical part was all good, but we failed to sell any such bed to hospitals, only a few to nursing homes. Doctors are conservative, plus anything related to medical requires a lot of certificates and compliances. Finally, we give up and made consumer device out of it - Sleep Numbers "smart bed".
Companies who sell software to doctors spend much more efforts to satisfy all requirements, and make a deal. Investment in user interface quality does not make sense because all decisions made regardless of it.
One rarely talked about aspect of this is that doctors - generally speaking - only trust other doctors. They won't buy an EMR system from someone without the necessary "street cred" - however well-designed that system is.
I know of a large EMR software provider that went as far as to hire physicians as salespeople because having doctors talk to other doctors made sales a lot easier for them.
Interesting! I think I ran head into this without realizing it. I prototyped a product for doctors at one point, and trying to even talk to them about it was quite a slog...
Is this really rarely talked about? In any field you have the leaders having to choose who they listen to. Dunning kruger is real, you have to have a way to separate the overconfident ones from the ones with actual clinical knowledge.
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.
There appears to be (almost) no true competition in healthcare, therefore no real incentives to improve productivity. Wages in healthcare rise disproportionately without productivity gains (Baumols disease); why invest in digitalization?
Wages in healthcare have decreased Year-Over-Year relative to inflation since at least the 90's. Productivity has increased in terms of the number of patients seen / day.
I'm not sure where you got this information, but it does not apply to Physician services who have gotten 5% year over year increases in medicare reimbursements.
Physical Therapists? Sure. But the American Medical Association is a fierce lobbyist.
The AMA is indeed a fierce lobby - just not for physicians. They are widely regarded as a shill for hospital interests rather than doctors or medical professionals.
Competition isn't the only way to hold down wage costs in healthcare. The UK system involves a combination of monopsony and economies of scale. (I make no other claims about the pros and cons!).
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.
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).
That’s still way better than being told to take two Panadol and come back in the morning if your symptoms don’t improve. I mean, 99% of the time it’s a seasonal virus and that’s all you could/should do, but 0.1% of the time it’s meningitis and if you don’t go to the ICU then you die.
and so here is the problem of personalised care in a system where you can see upwards of 30 unfamiliar people a day: sometimes patients would rather I look things up, and others hate the idea of me touching any sort of technology in their presence, and it's nigh-impossible to tell which they are until a good way through the interview.
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.
Science fiction, particularly space operas, can be dismissive of doctors. Most of the time the "doctor" is just a diagnostic machine that gives miracle meds and maybe 3d prints new body parts.
Maybe it's prophetic: authors saw the writing on the wall and decided a doctor is a glorified mechanic who works on the most boring machine around (which hasn't changed in 100k years). Or maybe authors just decide the space was better filled by an ex-space-ninja or similar.
My personal feeling is that medical practices have not evovled too fast with computing. Electrical engineering, mechanical engineering, biomedical engineering etc all contributed a lot to how doctors treat diseases. But whether medical records are digitialized or not is not significant. It helps, but does not increase cure rate. Old fashioned doctors have good reasons to reject. But they do not say no to new medicine, new devices, new procedures.
> My personal feeling is that medical practices have not evovled too fast with computing.
You should see "computing". Resizing a window in Windows has become a lost battle. Working with files on Android is a torture.
I really hope that "medical practices" will not "evolve", like "computing" has.
I fully reject your statement about not digitizing being insignificant. And there are several reasons for it, but the main one in my mind is about prevention vs curing.
In an ideal world where every medical record is digitized it would be possible to discover long term causal effects that nowadays we don't know because running long term studies is hard, costly, and in a world where publishing is everything they don't lend to it. So we explored and confirmed only the most obvious long term cause-effect connections.
Therefore, it would enable prevention of some diseases for which we, nowadays, can only have a reactive MO.
Numerous companies have already tried and failed with this approach to medical research. Naively you might think that you could just suck in huge quantities of de-identified patient charts to find all sorts of useful correlations between diagnoses, treatments, and outcomes. But this doesn't actually work because the data quality is so bad: garbage in, garbage out. Doing useful medical research usually requires setting up strict protocols for data entry and patient follow-up.
Fair, but I said "in an ideal world". Also, not sure if selling ads is more profitable to a product like a supplement because mining the digitized medical records showed that (example I pulled out of thin air) "constantly low potassium increases Alzheimer incidence by 50%" or similar.
Ehh, I think there’s a pretty consistent pattern of doctors rejecting pretty basic technologies or procedures that lead to positive outcomes for patients if it’s seeking to address the fact that doctors are human beings that can make mistakes. Medicine is a field full of massive egos.
Don't pity or excuse the doctors, they're smart and they know what they are doing. If their workflows with computers don't work, it's only because they make more money from this situation.
Something my doctor friends remind me of from time to time is how disconnected their actual workflows are from whatever system the money folks decided to buy.
People making the purchases are not the ones using the system and they hate it because it doesn't serve them... A tale as old as time.
For example, one of my doctor friends mentioned he has to scroll past an "order birthday cake button" at the top menu level so he can get to the order tests section and drill down to actually order tests.
This is a symptom of a deeper problem in medicine, the subjugation of doctors. It used to be that doctors ran their own practices and were the Götter in Weiß, the gods in white lab-coats. What they said was what happened, and healing patients was their purpose. Now, however, doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. If computer workflows are optimized for the suits rather than the doctors, that’s a symptom of a problem whose other symptoms, like rampant price inflation, are yet worse.
My company builds software for medical office assistants, and our clients are typically doctor-owned clinics. We have literally the same problem, but one step down the ladder. The doctors are making the purchasing decision, but MOAs are the direct users. And ironically enough, we have often run into the same problem. Doctors often don’t see the value in software that solves their subordinates’ problems.
>"Doctors often don’t see the value in software that solves their subordinates’ problems."
This was such a huge problem at my former company, Billit (getbillit.com), that our number 1 method on achieving clients was making such steep referral incentives for doctors, to their colleagues. We only needed one to make scale eventually happen, but the organic clients couldn't empathize with the workflows of their front desk - they didn't care.
At least in the US, many doctors (at least specialists) split off and created their own companies that then contract with the hospitals.
A large chunk of people working in healthcare are all contractors, now, with all the overhead and friction that comes with that.
The only true employees of most hospital systems are the finance people.
Indeed, and something else many people don't know is that a lot of (mid to senior) doctors have ownership stake in the hospitals, or are part-owners of the building that the hospital leases, etc. So it's not a direct "owernship" relationship anymore, it's more like a stockholder who works (contracts) for the company, sometimes with a hop or two in the way. I'm not saying this is good or bad (it doesn't seem at all clear cut either way to me), but it is something I found really interesting
A lot of that is to get around laws that say corporations can't practice medicine. These are state-laws, not federal so in every state it's different.
and facilities, cops, 'environmental services' etc.
Hospitals employ plenty of people to keep the machine running. No one wants a localized rainstorm in a surgery bay.
>doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine.
Is that actually accurate? The American Medical Association (the Physician cartel/trade association) bribes/lobbies about equal as hospitals/owners.
They also legally reduce supply using their private, unelected, ACGME.
If we use lobbying numbers, they are just as obsessed with money as the owners.
I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.
Why is the government paying for graduate education? I paid for my own graduate education.
The costs would be utterly extortionate otherwise.
No. Don't let the cartel propagate this lie.
Who decides the funding?
Funding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.
You are not mistaken. Contrary to the conspiracy theories you see on here about the AMA, lately they have been lobbying Congress to increase funding for residency programs because that is the primary bottleneck to producing new physicians.
https://savegme.org/
So after studying for a decade a soon-to-be physician needs to go through a government funded job in order to qualify as a physician?
Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
Anyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies.
If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.
> Most residents generate less revenue than they cost to train.
Is this just a thresholding issue? What substantially changes about the resident from year 1 to 3? Can you chop residency up into different tiers where they don't need somebody watching them do stitches once they're no longer the lowest tier?
I find it extremely suspicious that a sector with so much money in it can't figure out how to make apprenticeships profitable but an electrician can.
You seem to be confusing amount of money with actual control. Electrical contractors can charge any price they want (subject to customer demand). Hospitals, especially teaching hospitals, have no such freedom. Medicare reimbursement rates are fixed by government fiat. This is not a free market.
Residencies are already chopped up into tiers. Those with more experience have more clinical and administrative autonomy. But for the most part, Medicare doesn't allow hospitals to directly bill for work done by residents. With a few limited exceptions, all of their work has to be supervised and signed off by a qualified attending physician. This training and supervision is extremely expensive.
Any major reforms will have to come at the federal government policy level. This is not a problem that medical schools and teaching hospitals can solve by themselves.
I think it is primarily a matter of insurance expectations and regulation of residents. It dictates what services they can bill for and the amount of redundant oversight required.
It is a self imposed problem.
The problem is largely imposed by Congress in terms of strict rules about what hospitals are allowed to bill Medicare for. This is not something that teaching hospitals have imposed on themselves.
correct, I didn't mean to imply it was by the hospitals, although the teaching hospitals may still benefit from the current arrangement.
Uh... You are talking about the highest paid profession in the US.
There is no debt problem.
I joke about how bad doctors are at math, but this is a pretty obvious case when Physicians are making 200-500k/yr and complaining about 300k of debt.
300k of debt sounds kinda low.
https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
> 2024 Median Pay This wage is equal to or greater than $239,200 per year or $115.00 per hour.
> Physicians and surgeons typically need a bachelor’s degree as well as a medical degree, which takes an additional 4 years to complete. Depending on their specialty, they also need 3 to 9 years in internship and residency programs. Subspecialization includes additional training in a fellowship of 1 to 3 years.
So on ~240k you pay ~50k takes just to the federal government and we'll say 12k to the state. 178k is still pretty good, knock out 80k for living expenses (better not live on the coasts) and you're left with 90k which would (naively) pay down 300k debt in 4 years. That said, you're also probably 30 with a net worth of 0$ and could've done a different career path to make ~240k per year without a decade of education.
Hahahahahaha 4 years to pay off education for the most lucrative profession in the US. (And you assumed 80k/yr for living expenses... whats the median income in the US? 50-60k? hahahahaha)
Yeah thats a steal.
You can't really paint this in a negative light.
Median household income is 80k [1].
It's really easy to paint this in a negative light. You can go study for an extra decade to be a doctor to make as much money as not studying for a decade and working in fang. Becoming a doctor over many over professions puts you literally millions of dollars behind. Doctors are not the most lucrative profession.
[1]: https://fred.stlouisfed.org/series/MEHOINUSA672N
You're really missing the point. There is a huge variance in physician wages based on specialty and location, to the extent that looking at averages is mostly meaningless. We already have a growing shortage of physicians, especially primary care providers in rural areas. Asking prospective doctors to fund their own residency slots will only make that problem worse.
>shortage of physicians
>Asking prospective doctors to fund their own residency slots will only make that problem worse.
Its literally the opposite.
If you have them fund their own spots, there would be potentially unlimited spots.
The limit is caused by the boogeyman of not getting government funding, not that people can't afford the temporary debt.
There was some stat that 1 in 4 qualified people become doctors. The problem is not supply. The problem is the cartel legally reducing supply to prop up wages.
> Now, however, doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine.
Just one more way that private equity ruins the world.
I read elsewhere on HN - "Well-meaning users will always quickly turn an unusable secure system into a usable insecure system."
The corollary is that a perfectly secure system is one which is completely and utterly inaccessible to anyone, including the users.
I always like this when explaining why the A in the CIA Triad matters: The most secure computer is one powered off, encased in cement, and dropped into the middle of the Pacific Ocean. But it's not very useful
“A ship in harbor is safe, but that is not what ships are built for.”
If the system is unusable some well-meaning user will set up their own system, which is unlikely to be secure.
Hey now, don't knock on batch processing systems.
It's called selling to the C-suite.
But it's not just about money, its about compliance too. If you can tell a higher-up "Use my software and you'll never have to worry about another compliance issue" that's also pretty appealing regardless of how well it fits the current workflow.
And the best part is you don’t even have to be right!
that's for sure. It's not called "Selling to the people who use the system"
> Something my doctor friends remind me of from time to time is how disconnected their actual workflows are from whatever system the money folks decided to buy.
There are two ways EMRs get made. They start from the money side and grow into clinical, or they start in clinical and grow into finance. This means however they started, that's what it'll be strong in.
I would absolutely love to get to help design an EMR. A huge part of my job is finding ways to help our clinical staff spend less time in the EMR and more with patients. There's so much room for improvement, but it's a hard market to crack.
You are absolutely correct about it being a hard market to crack.
My wife, who is a doctor, often complains that the various systems she has to deal with are often unusable.
When I was designing my new, general-purpose data management system that handles both structured and unstructured data well; she begged me to try to come up with a better system to manage medical data.
While I think my system has the potential to make a much better EMR; the work and money needed to break into that market felt beyond my reach.
A little startup with a superior architecture, but without all the political influence and domain knowledge to navigate the medical world; has little chance of gaining a foothold.
Also known as the Blackboard problem... It has to be the worst software I ever had the misfortune of using, because the people who choose it (admins) are not the ones who have to use it (profs and students.
Also quite telling that when you go to Blackboard's (now called Anthology, apparently) site, 75% of it is dedicated solely to AI.
You get a small blurb about "Experiencing the power of Together™", whatever that could mean, some small product description, of course all "AI-enhanced" and then lots of fluff about "industry-leading AI capabilities", "responsible/ethical edtech AI", "AI roadshows", etc.
So much ado about what's definitely just an annoying ChatGPT wrapper button that most will definitely quietly learn to ignore... :)
It's a multimillion dollar business entirely dedicated to the enterprise of selling Blackboard to schools. With the side-effect of producing a terrible piece of software.
That’s how Jira works too.
I'd order birthday cakes daily just to prove a point
1. He's paying for the cakes.
2. You're improving the metrics of the people who put it there.
A better strategy would be to call the support desk stating that you can't find the order tests section. Then when they tell you where it is, state that you assumed you were in the wrong menu due to the presence of the obviously unrelated order cake button.
Does product support talk to the developpers department though?
In most companies I worked at it was like they deliberately made it hard for those departments to communicate.
You may be pleased to know that you can do this via the GDS system for meal preference when booking flights by using the code CLML ("celebration cake meal") if your travel agent is cool.
Here's a reference, as well as other options: https://worldgo.ca/understanding-your-airlines-meal-options/
I know the best doctor you'd ever have the privilege of being treated by. He's smart, kind, knowledgeable, experienced, and has a gift for noticing things others miss. I'd meet other doctors that knew him and they'd say he's the kind of doc they'd want treating their mothers.
He has never been great with computers (though he often reminds me that he successfully created a boot disk with virtual RAM to run Falcon 3.0 on my IIGS when I was a kid). He's not totally incapable of using modern tech, but I am his tech support and we still occasionally deal with basic stuff like how to forward in gmail or save a PDF on his phone.
I remember when his hospital switched to EMR. It was a nightmare for the first six months, but he eventually got the hang of it. Some of the other older docs requested assistants to help them but he was stubborn and prefers self reliance if he can help it and just gutted though it.
That was years ago and I far as I can tell the doctors in his circle are very used to EMR now. I hear some are even liking new AI features that listen to an appointment and automatically draft notes (that the doc obviously must review and sign off on).
My dad retired this summer after more than 40 years of 60-80 hour weeks saving and improving countless lives. He still struggles with computers, but I don't know much about medicine so it's more than a fair trade of advice for me.
I’ve been looking for a good doctor for a while. I’m assuming that you were talking about your father, but if you know anyone you’d recommend (in US) I’d be very thankful.
AI features that .. WHAT?
How does that work? Are you saying that personal doctors appointments are being live transcribed by microsoft or openai?
Over. My. Dead. Body.
That ship has sailed. And that isn’t the only use of AI in medicine. Radiology gets AI generated referrals that the referrer (apparently) reads before sending.
The MR images has signal added by AI in k-space. Then the frequency domain data is transformed to images and AI doubles the resolution (Thanks Siemens deep resolve). Then PACS checks for various things depending on what radiology paid for (stroke, lung lesions, fractures, breast lesions).
The report goes out, ready for your follow up appointment.
In the US maybe, it seems normalised for people to run cctv inside their own homes even.
Can’t see it happening here (eu).
I’m in New Zealand.
At my last doctor's appointment the nurse asked if I was okay with AI conversation transcription and summarizing that the doctor uses. So I had the option to decline.
I'm not sure how I feel about it yet. There are contextual details you might include when talking to your doctor that you wouldn't expect your doctor to write down into your medical record.
There are hordes of startups working in that space, generally using HIPAA-compliant cloud services and/or on-device models, with different startups focusing on different specializations.
I would count them among the most viable startups in the AI space (implementation-wise), and also among some of the most necessary with the aging population. They are also compared to other places where AI is trying to be employed in the healthcare sector on the "lower risk" side of things (doctors still are accountable, and the benchmark are the current badly hand-typed notes).
Oh so the recording is being sent to a compliant service. That’s okay then. I’m sure all these doctors practices with their creaky dusty monitor mounted windows 10 thinkstations absolutely can’t be hacked or that the data could never fall into the hands of the government or anyone else.
Bananas. Why are we letting this happen?
So you are objecting to general electronic processing of healthcare records then?
Not sure how that is realistic in a world where insurance exists, unless your ideal is paper documentation and paying privately for your treatments in fiat. If that is what your after, I guess we've already been in a "over your dead body" world for decades.
No, my doctors surgery is fine to store my patient records internally (e.g on-site).
But no it’s not fine to store those externally without my express written permission , or make recordings and send them to a third party.
It’s realistic here — this is how it works in Germany for decades and i’m fine with it.
edit: storing these on an american cloud provider, or any cloud provider really counts as a third party to me, also.
I doubt if they're using raw MS or Open AI models (because the whole thing would have to be HIPAA compliant) but yes, some doctors will now ask if you consent to them using AI tools to transcribe the appointment.
Honestly, what’s the big deal? Before it was ai transcription they still used transcription a lot it was just algorithmic.
If your concerns are about privacy, that’s a seperate issue regardless, whether it’s AI or not doesn’t mean the data is being shared or not, and same with the transcriptions from before.
Yes privacy.
Maybe i’m just a crazy european but I find the concept of always on recording devices completely insane, let alone one in a doctors office.
I dont see how that’s a “separate issue” — separate from what?
> AI features that .. WHAT? ... Over. My. Dead. Body.
That in fact may be the exact outcome.
> Over. My. Dead. Body.
Maybe literally depending on where you end up dying.
> EMR
Elastic map reduce? The servers AWS provides for running big data processing tasks?
electronic medical record
no more paper stuff so rather some software where they have to type all the details into the computer
https://archive.ph/PlnQl
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.
Deja vu...
https://news.ycombinator.com/item?id=44778004
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.
Dentistry has changed in the last decades. If a dentist refuses to use useful computer things, I instantly wonder if they are also out of date with modern best practices. Better materials for infills and stuff like that.
I'm in the process of having some dental implants done and the process is amazingly high tech - I was particularly impressed at the 3D model they created from CAT scans that they then use to position instruments during work - they attach something to my teeth to tell where my head is and the software guides where the instruments should go based on 3d sensors.
Wouldn't surprise me if they went fully robotic for some things in the not too distant future.
I've been with my dentist for a while and in the last 10 years or so I think they've updated their X-ray machines twice. It used to be a massive machine that was in a special room, which they'd use to take multiple photos of your face by wheeling around. Then they got a smaller one that could be right next to your chair, and they'd make you bite down on some film while they moved an arm around with the source on it. Recently they have a new machine that you put your head in and it just seems to do the whole thing in one pass.
The head thing might not be doing the same x-ray as the bite thing.
I'm impressed they only got the bedside one recently. My dentist just recently upgraded to direct digital sensors for their x-rays (wires to the computer in the room instead of digital plates), but the X-ray source shows decades of battle scars.
I did ask a dentist once about why the roots of my wisdom teeth were so strangely distorted in an X-ray and they carefully explained that there was no distortion and they really were that shape...
>Better materials for infills
My mother is a dentist on the verge of retirement who used to fly to conferences all the time and ran a reasonably successful dental practice with about a dozen employees (and plenty of computers). She would always talk about how the new implant ceramics are not as durable as the old amalgam and they're only popular because they're white instead of gray.
If you're in the US this might be for a specific reason.
If you're a medical facility that isn't digitized then you're not subject to many of the HIPAA privacy and security compliance rules. It's an exception they carved out to grandfather in older practices that weren't digitized.
Many facilities stay "analog" in that way for that explicit reason.
Source: used to be a certified HIPAA Security Officer, this was a topic at the certification seminar I attended.
Then again, paper can't leak as easily as a database
Are the security requirements of HIPAA good? (genuinely wondering: your data goes to tons of organizations, any of them could use a not properly secured database and leak it. And are the requirements good both in the technology and practices, as who's accountable?)
I'd say they're not bad.
Any data processing by a third party must be done under a Business Associate Agreement (BAA), which transfers responsibility under HIPAA with the same rules and regulations to the third party. There's always a chain of liability when processing PII, traceable back to the PCP (primary care provider).
The regulations also leave things open ended in terms of specific ciphers etc, stating "industry standard" encryption at rest and in motion (i.e. transport security) must be used, for whatever definition of industry standard is correct.
As for privacy, exfil of PII even in non-digitized establishments is still covered (hence why there is typically also a Privacy Officer appointed with a HIPAA complaint org, distinct from a Security Officer, both being actual terms and certifications being handed out by certification bodies). That covers general privacy and a much larger scope, and applies to any healthcare establishment - not just those who use computers.
Cryptographic audit trail requirements, third party audits and reviews, a slew of other software certifications (some even from the government, such as Meaningful Use), etc all exist to help with that mission.
As for who's accountable, it's always tied to the processor of the information, and "breaches", which are violations of either privacy or security policy, must be reported all the way back up the chain in a timely matter, and in the event the breach might cause risk of harm or disclosure, must also be reported to a regulatory body (I forget which), in which case the offending party must pay a fine. There's insurance for these scenarios, I forgot if it's compulsory. But it racks up fast, and IIRC you're liable in most cases for damages up to a ceiling, somewhere in the 9 figure range.
What's more is that there's also Qui Tam lawsuits which, as I understand things, can be brought against an offending healthcare establishment by a whistleblower of sorts (i.e. a third party who observes a breach, without being part of the chain of responsibility (the healthcare establishment) nor affected by the breach) on behalf of individuals harmed by said breach. As far as I know, anyone can do this.
IMO, for what it tries to do, I think it does an okay job. It's a really difficult thing to generalize and standardize given not only the flux of technology but also the fact that you still want independent innovation in the space without regulatory overreach.
(This is a massive oversimplification of my slightly outdated knowledge of this as I've been out of the US healthcare field for a while now)
Why would my care be better if a doctor goes through a paper folder instead of a digital one?
It’s not how the records are kept per se.
It’s that the paper-using doctor can spend more time on you, the patient, instead of fighting with a balky UI and inane business rules.
A relative of mine had to go back to their paper-only specialist a couple of months ago to get a prescription reissued because the specialist had omitted a mandatory detail from the (handwritten) prescription form and the pharmacist couldn't fill it.
Meanwhile, I had a similar prescription, from a different specialist, who issues his prescriptions as either e-scripts or computer-generated paper scripts depending on patient preference. I suspect his practice management software would stop him from making this class of mistake entirely.
I get why a doctor might prefer to avoid the computer, but I think my relative would have preferred their doctor not screwing up on something basic and wasting a significant amount of their time over better vibes in a consult.
Ive had so many problems woth e prescribe. Half the time its "just not working right now" the other half they send to the wrong place, or they send to a pharmacy that doesnt have supply and you cant find out that theyre out of stock until they recieve the script. At which point you have to cancel and then contact your doctor to resend. Which can take several days. Whereas with paper prescriptions you just drive to the next pharmamcy.
Theres pros and cons to both
Why would that necessarily be the case? I understand that bad software can get in the way of anything, but I find it hard to imagine there is nothing out there that actually helps any given (and willing) physician to improve their work, and make more time for patients, not less. There are inherent properties to IT that can help make stuff more efficient across any domain I can think of, and physicians work checks a lot of the marks.
I happen to work in the medical field and while a lot of the software involved has its issues, not working with software, at this point, seems like a really bad idea, in terms of error prevention, performance and efficiency.
I'm a physician. To understand why this is true you have to understand that the software is not intended to the make the physicians jobs easier or more efficient. The point of modern EMR's is to take every patient encounter and generate a list of billable codes that maps onto the encounter in such a way that insurance companies are less likely to send it back. The stuff like checking medication interactions is just tacked on as an afterthought. Through this lens everything else makes more sense.
Not necessarily, no, but empirically yes.
Paper-shuffling used to be not a major issue in a doctor's work day. It was merely something that yes, sure you had to log new patient data and whatnot for reference, but you were mostly free to do the paperwork in a way that fit your natural workflow. Based on the doctors I know/knew, it was not a pain point. Yeah, you would sometimes have to fetch physical papers from somewhere instead of clicking yourself to the same information on the computer, but that was not a major issue. I'd say it was similar to a programmer who's waiting for an incremental compilation to finish: a minor moment out of actual work but nothing to fret about.
After doctors' offices got digital then interacting with the computer specifically certainly became an issue which didn't exist before. At best, it was just a clumsy way to do the inevitable and at worst it became a major part of the patient visit, with myriad of odd tricks you had to learn about some particular computer software in order to accomplish your actual goals.
If something that used to be normal part of work nobody thought twice about once become noted as a separate issue of the work day, something did change there. Sure, there are benefits too, but it's the friction points that you feel at work when you're trying to get other things done. Sure, software could be written to serve the user and not the other way around, but software rarely is -- no matter the profession, doctors aren't the only ones!
My old family doctor used to have IBM terminals into the early 2010s, I'm fairly sure there was an AS/400 somewhere in the back rooms where all the serial lines in their practice converged. Very fast system. Meanwhile I was at a specialist some time ago and they had to switch back and forth between notepad and the medical app, because you can't enter more than a few words at once into the app. So he would write everything that's not a drop-down in notepad then copy-paste it.
Well for one thing it's much less likely for someone to steal 36000 therapy files and extort people into suicide when they're stored decentrally on paper in locked cabinets instead of ~~the cloud~~.
https://en.wikipedia.org/wiki/Vastaamo_data_breach
Not sure what being personable has to do with knowing how to use a computer.
This has nothing to do with "knowing how to use a computer."
Looking at a screen while you check through dozens of flags and billing related documentation instead of looking at the patient is much less personable.
could it be that wasted time and added stress make you less empathetic?
I can see that working today in dentistry more so than general practice. I’ve got medication that insurance has dictated that I need to refill a weekly med monthly and it arrives precisely the week I need to take it. I need to time my vacations around this med now.
I get that I’m ranting against healthcare and not doctors, but I’d run far from any doctor that’s paper only these days.
I disagree. It’s wasteful spending your day trying to read doctors hand writing. There are dozens of other issues that come from technical incompetence, but the handwriting one alone is a vast waste of time and money.
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.
It's not just filing the X-rays. Back in the day, for a big crown you got yourself a full mouth cast, ship it away, and eventually you got a crown which hopefully fit. Today you get a much less invasive scan before the root canal. one after, and the 3d printer in the back creates a crown that fits. Much faster, cheaper and typically even more accurate.
to quote Wendell Berry, “the more superficial and unsatisfying our lives become, the faster we need to progress"
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.
Dental software is terrible as far as I can tell. I’m at school /practice were the staff cheered loudly when it was announced they were planning to upgrade or change vendors.
I never saw such passion about software.
> 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.
They stopped the improvement around Win 10. Since then, everybody (Microsoft, linux, Apple - Google never had a wheel) is reinventing a worse wheel, regularly.
Eh...I'm all in for doctors who can actually take emails than just phones. I fucking hate talking over phones. I don't need "family" doctor. I need a family "doctor".
HIPAA doesn’t exactly make that illegal, but it comes so close that approximately zero doctors would be willing to skirt that line and risk the enormous penalties if they guess wrong.
All major EHRs now have some sort of patient portal with secure (HIPAA compliant) messaging built in.
Sure, but patients don’t want to sign up for yet another portal. Unfortunately, the methods they want to use may not be practicable options.
Me(2010 ish): Hey can I get my x-ray pictures before I leave?
Doc: No, there's no way to get pictures off of this computer
I had the pictures saved on a flash drive about 30 seconds after he left the room. They were using some awkward browser-based system where everything was served as an html page. It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.Just a personal anecdote.
> It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.
That doesn't surprise me, for the same reason I can't tell you what a metatarsal is without googling.
What did surprise me, was that my dad had a home PC with internet for years before realising that Google search results had a scroll bar — it's not like he didn't know how computers worked, before retirement he'd been working as a software developer for one of the big UK defence contractors.
Can't comment on Google specifically but hidden scrollbars mean I often don't realize a dialog has scroll bars until I reach out into the dark edges to find what I hope is there. Microsoft will even harness this as a dark pattern to hide options they don't want you to choose.
Perhaps your dad simply expected to scrollbars to be visible like they initially were.
This was before scrollbars got routinely hidden like that, it was in the mid to late 2000s. He retired in the late 90s.
The longer I live, the more I see Physicians as people who are bad at math and/or who have parents who are physicians.
There are a few people that are nither, but I think its safe to say at least 50% of physicians qualify as this.
Metatarsals don't come up in your daily work. Using a computer is a constant daily task for a doctor. In this example he failed to use it properly and just said it didn't work instead. That's not really OK.
Almost certainly saving the image was a violation of hipaa policy— giving emr records without the proper logging/etc can get the doc fired. The patient had a right to their images, but it’s like anything enterprise, getting it has to go through the proper channels.
You can probably imagine the privacy problems if that image were saved out of the cache directory.
I don’t think criticizing doctors for not knowing you can right click save image as makes any sense because it’s not an important part of their work.
> years before realising that Google search results had a scroll bar
If that happened now he would have never seen anything except adverts.
Sometimes I see almost only ads not on the first screen but on the first _page_.
Imho, the first thing doctors need to learn (at least in my country) is to touch type. I've had it with 5 min exams followed by 15 minutes of pecking to type in the necessary forms. Multiply by number of patients in a day and it adds up, and it's prevalent, family doctors, dentists, specialists, nobody bothers to learn it. Gets tiresome when you know you're in the waiting room for a couple of hours because they are slow at typing.
I used to do support for a service that did transcription for doctors. The doctors would call in and tell the medical transcriptionist what to type and they would do the input.
It always seemed incredibly inefficient and expensive but hospital management told me this was the most dependable way to get accurate records and even a single lost lawsuit would cost more than the service.
It's stupid, but that's the world we live in.
No. Just no. Teaching doctors touch typing is tending to the secondary symptom of the fact doctors should not waste time inputting routine data.
What doctors need would be secretarial services trained in medical procedures.
And by the way, when I was a child, even before the computers came, here is how it worked in Russia.
The doctor was listening to my breathing, looking at the throat, asking me and my mother questions, and saying various medical phrases to her assistant, who was then writing them into my patient records (a thick paper notebook).
This is how all the dentists work that I've seen. Doctor plus nurse. Apparently dentists have more agency over their work environment than doctors do.
I think this is one of the use cases where speech-to-text and (AI) transcription tools would be useful. Of course ideally there'd be two people, one doing the medical stuff and the other then documentation, but health care is expensive enough as it is.
Medical scribes are a thing. Some provider organizations employee people who attend patient encounters and do all the EHR data entry in order to free up clinicians for higher value work. This generally works well, but it is expensive and payers don't directly reimburse for that service.
All the dentists I've ever visited have worked in doctor/nurse pairings. The nurse assists in operations AND is the data entry expert.
I think it's just about bureaucratic faux-economical thinking infringing to doctors workspace cutting overall effectiveness.
It turns out that peach to text is slower than dictating and having a typist type.
The speed at which reports are dictated is incredible and even when familiar with the field it’s hard to understand how the typists are getting it right.
> Of course ideally there'd be two people, one doing the medical stuff and the other then documentation, but health care is expensive enough as it is.
In the 1980s USSR, every doctor actually had a nurse who did the paperwork. And somehow, healthcare was still free.
What we need is a universal standard way to store all of our personal data on our phone and share whatever is relevant at whatever company/government at the touch of a button.
Nor a secretary nor a doctor nor anybody should have to hand-type data that already exists digitally.
I'm so mind-blown that this doesn't exist yet that I feel maybe I should try and build it. I have tried building the next-best thing: OCR based form filling, but hard to get far as a solo FOSS'er.
" this doesn't exist yet"
We have a national health database in Finland called "OmaKanta" (which translates to MyDatabase or something like that). It's not perfect but at least I can trust it with most of my health records, and it's accessible to all doctors working in both public and private sector.
Many healthcare provider organizations have standard HL7 FHIR APIs that patients can use to download their own chart records. There are a variety of apps that you can use to call those APIs.
Im talking about a standard GLOBAL way of sharing that exact same data AND all other personal data.
FHIR is a global standard.
Problem: there are 19 competing standards
New problem: there are 20 competing standards
There are 0 standards for global sharing of all possible personal data. That I know of.
I wonder if the Solid protocol might be helpful here? [0] I must confess I haven't toyed with it so far, but I am looking for an excuse to try it out.
[0]: https://solidproject.org/
Looks cool, but is more abstract/low-level than what I mean. Could maybe be used as a foundation for it though.
Touch typing for doctors seems a waste of time now that Dragon / Whisper / your phone can do Speech to text quickly and relatively reliably.
Sure, let’s send private medical data to a cloud server somewhere for processing, because a medical professional in 2025 can’t be expected to know how to use a keyboard. That’s absurd.
I can type quite well. I can also troubleshoot minor IT issues. Neither is a better use of my time than seeing patients.
I’m in an unusual situation as an anesthesiologist; I don’t have a clinic to worry about, so my rate-limiting factor isn’t me, it’s the surgeon. EMR is extremely helpful for me because 90% of my preop workup is based on documentation, and EMR not only makes that easy but lets me do it while I still have the previous patient under anesthesia. I actually need to talk to 95% of patients for about 30 seconds, no more.
But my wife is primarily a thinking rather than doing doctor, and while she can type well, why in the hell do we want doctors being typists for dictation of their exams? Yes, back in the old days, doctors did it by hand, but they also wrote things like “exam normal” for a well-baby visit. You can’t get paid for that today; you have to generate a couple of paragraphs that say “exam normal”.
Incidentally, as for cloud service, if your hospital uses Epic, your patients’ info is already shared, so security is already out of your hands.
This has been happening for years, long pre-dating LLMs or the current AI hype. There are a huge number of companies in the medical transcription space.
Some are software companies that ingest data to the cloud as you say. Some are remote/phone transcription services, which pass voice data to humans to transcribe it. Those humans then store it in the cloud when it is returned to a doctor's office. Some are EMR-integrated transcription services which are either cloud-based with the rest of the EMR or, for on-premise EMRs, ship data to/from the cloud for transcription.
Macs have pretty decent on-device transcription these days. That’s what I set up for my wife and her practice’s owner for dictation because a whole lot of privacy issues disappear with that setup.
The absurdity is that doctors have to enter a metric shit ton of information after every single visit even when there’s no clearly compelling need for it for simple office visits beyond “insurance and/or Medicare” requires it. If you’re being seen for the first time because of chest pain, sure. If you’re returning for a follow up for a laceration you had sewn closed, “patient is in similar condition as last time, but the wound has healed and left a small scar” would be medically sufficient. Alas, no, the doctor still has to dictate “Crime and Punishment” to get paid.
Most EHRs are sending that text input to the cloud for storage anyway. Voice transcription is already a feature of some EHRs.
Medical companies could self host their speech to text translation. At the end the medical data is also on some servers stored. So doing speech -> text translation seems just efficient and not too much worrying if done properly.
So you think the better solution to doctors not being able to try is for them to self-host a speech to text translation systems, rather than teaching doctors to type faster?
Their healthcare/IT provider like Epic would do it. And in fact some have already done it, from what I can see.
Furthermore, preparing/capturing docs is just one type of task specialization and isn’t that crazy: stenographers in courtrooms or historically secretaries taking dictation come to mind. Should we throw away an otherwise perfectly good doctor just for typing skills?
Who is responsible when the speech-to-text model (which often works well, but isn’t trained on the thousands of similar-sounding drug names) prescribes Klonopin instead of Clonidine and the patient ends up in a coma?
These models definitely aren’t foolproof, and in fact have been known to write down random stuff in the absence of recognisable speech: https://koenecke.infosci.cornell.edu/files/CarelessWhisper_E...
This isn't a speech recognition problem per se. The attending physician is legally accountable regardless of who does the transcription. Human transcriptionists also make mistakes. That's why physicians are required to sign the report before it becomes a final part of the patient chart.
In a lot of provider organizations, certain doctors are chronically late about reviewing and signing their reports. This slows down the revenue cycle because bills can't be sent out without final documentation so the administrative staff have to nag the doctors to clear their backlogs.
I imagine where the speech to text listens to the final diagnosis (or even the consultation) and summarizes everything in a PDF. Of course privacy aware (maybe some local hosted form).
And then the doctors double checks and signs everything. I feel like, often you go to the doctor an 80% of the time they stare at the screen and type something. If this could get automated and more time is spent on the patient, great!
None of those options are off-device.
> now that Dragon / Whisper / your phone can do Speech to text quickly and relatively reliably.
It’s less accurate and much slower than a human typist (or 3) typing dictated reports.
Tested over years in an MSK radiology clinic.
Wait - you accessed your doctor's computer after he left the room and downloaded data from it?
Sure did! I think you're vastly overestimating the security of... basically everything computer related in the 2010 and earlier era.
I did not poke around obviously, because I was only interested in my personal files and assumed I only had a few minutes. Could I have been 'evil' and accessed other stuff maliciously? Maybe idk.
Years before I also had root access to my entire school district's records and probably could have wiped them if I really wanted to. I'm not a hacker or programmer by any means, just a random idiot that figured out how to use ophcrack back when XP was the primary operating system. It was a different time.
I'm mostly just surprised that the doctor didn't lock the workstation when they left the room. Especially if it was a radiology workstation (rather than e.g. exam room EMR workstations); the sensitive data risk from leaving it unlocked is huge!
Like, I'm not saying that'd solve computer security or anything, someone could still break into a locked computer. But it would definitely raise the level of effort required to access medical data up from "has a flash drive and five minutes".
I'm sure doctors get the same lock-your-workstation trainings as the rest of us, and ignore them about as often. I wonder if smartcards would be appropriate here: since doctors are typically jumping between lots of "thin-client equivalent" computers around their practice all day, could we give them smartcards that need to be physically inserted in computers in order to log in? Pull the card, computer logs you out; don't forget your card in the exam room or you can't log into the next one.
Like, I'm sure they'd have tantrums (any kind of users would, at this transition), but putting that aside: this kind of system is technically cheap and has been well-supported for decades. Would the overhead of employing it at medical practices be preventative? Is it already employed at some practices? How does it work there?
> I think you're vastly overestimating the security of... basically everything computer related in the 2010 and earlier era.
My astonishment is unrelated to IT security. Your behavior is equivalent to just sneaking into the unlocked office of your doctor and taking photos of your file.
Well what's the alternative? Get in a week long battle with the hospital while they struggle to locate and send a 500kb jpg? I AM talking about the American healthcare system here.
Yeah, I'll just grab it myself. It was a standing workstation right in front of the exam table and he didn't even close the browser. Would have taken 3 seconds to lock and unlock if they cared about security.
Makes you wonder if they could have accessed and saved data from other patients as well.
"I topped up my bank account within 30 seconds after the bank clerk left the counter."
My experience as well, in a hospital a doc left me with sa fully logged in console, to feed my kid in his office (which is incredibly kind of course). I for one got that "walk afk = alt-f4" rammed into me at my work place at that time. Makes me think that there might be a face-id like unlock (and immediately lock) market out there for PCs...
I expanded on this in an adjacent comment: smartcards might be a cheap and easy solve here. Insert the card to log in, pull the card and you get logged out. Bonus points if the smartcard is also your access card for e.g. the break room.
Albeit whatever others said, I think it's PERFECTLY fine that you did that just for your own record. I'm not being cynical. Getting my own medical records is far from easy and I don't give a fuck anymore.
Will I do it? Probably not. But I salute all who does.
I wish people had basic computer skills too but I think it's a failure of software design if you expect a random working professional to know how to work around the lack of obvious functionality?
It’s even more concerning you obtained access to this system with ease. Sounds like a pretty serious security incident.
They probably just meant that protocol prevents them from giving you access to them.
My trick was to photograph the screens with my phone. A lot of the stuff wasn't html and genuinely quite time consuming to figure how to send.
Medicine is such an all-consuming pursuit that I'm entirely NOT surprised that a doctor might not have great computer skills.
Not knowing how to pull an image out of a web page is not something that will impact their ability to diagnose your malady.
Your flash drive must have been compromised. Every flash drive from med students are infected with viruses.
You'd think they know better and practice safe insertion.
This points to a wider misconception that the public has. Computer engineers learn how to build computer systems, they don't learn how to use computer systems. Automotive engineers are not necessarily good drivers either, and an architect can get lost in your building just as well as anyone.
Sure you get a lot of it through osmosis by spending a lot of time at the computer, but computer science professors struggle with projecting slides from the in-class computer just as much as high-school teachers.
My point is that, sure, it's reasonable to expect a doctor to know absolutely nothing about programming. But if using computers is such a central aspect to their job, it's not unreasonable to expect that they will be proficient in operating medical computer systems, probably better than computer engineers.
I'm not talking about programming. I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions, even those that are arguably more important.
Do you have basic knowledge of your own body? Anatomy, for instance? I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Or how many people who drive know what a catalytic converter is, or what symptoms are typical of it failing? Or even what to do when certain idiot lights light up on their dashboard? The check engine light comes on, do you stop on the side of the road or can you continue to your destination? Or can you continue, but just to a garage? Do you have to do so at reduced speed? How about if the oil light comes on? How about if the low tire pressure light comes on? How about if the airbag light comes on? How about if the battery light comes on? How about if the light with an exclamation mark inside a triangle comes on? How about the light that looks like a profile of the car with skid marks under it? How about the light with the cryptic three letters ABS?
> I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions
That was their point: keyboard, mouse, and basic computer interaction is general knowledge that anyone in modern life should have, like first aid or what traffic signals mean (for both vehicles and pedestrians).
Yes, and the doctor in question is skilled enough to use them. He uses them via hunt and peck, not touch typing, but that's good enough for his purpose.
> I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions, even those that are arguably more important.
I'm a bit confused about what you are saying. Basic use of a keyboard and mouse is not exclusively part of the software engineering or IT profession. It is in fact part of every job where as part of your job you use a computer. Which is almost every job nowadays.
Same as writers are not the only people who are taught how to write, and accountants are not the only people who are taught arithmetics.
> I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Sorry to hear that, and I hope you are feeling better. Not really sure though what is your point. Are you saying doctors should not know about basic use of a keyboard and mouse because you haven't heard of the rotator cuff? Or are you saying that people should be also taught about the rotator cuff who are not doctors? I just don't really understand your point.
> Or how many people who drive know what a catalytic converter is, [...] How about the light with the cryptic three letters ABS?
I'm really not sure what your point is.
I'm saying that we should not expect people to use computers efficiently, rather we should expect people to use computers in a "good enough" fashion.
I think that more cross-discipline experience would benefit everybody.
Come now. You mean to tell me the same doctor doesn't use a computer at home, write emails, make an occasional document or spreadsheet for tax purposes, doesn't carry a smartphone in his pocket, text other people?
A doctor is a human being, not a specialized insect.
He does all that. And for him, hunting and pecking is efficient enough.
I know basic things like cpr, how and where to apply pressure to stop bleeding, signs of a stroke or hypothermia, you know, basic vital stuff to keep someone alive in case of emergency.
Similarly, I'd expect a doctor to be familiar with things such as "save as" or "print screen" if they used a computer every day.
I work as a software engineer and a manager in a medical devices company, but also as a hobby, whenever I'm at the doctors, I always ask them to show me the systems they're using.
A few observations: * software for medical devices is obscure, usually still done with 90s/00s technologies, people in the field are underpayed too. The result is you get bad code and most of the time you're just maintain it, instead of implementing new stuff, * this applies to both software and hardware - amount of often useless paperwork is ridiculous. You're bound by a lot of standards and regulations to make software/hardware compatible with those regulations. Which means engineering is not doing much engineering, but rather fillout those docs, do countless reviews of them, spend a lot of time on testing and QA. I know a few of those standards by heart, and often the work is not about implementing a standard but rather about being complaint with the standard - aka interpreting and stretching them that whatever you do is kinda complaint, but not really following the rules * software to manage these docs/requirements is also from 00s/90s, super not intuitive * med software itself, like stuff used by a doctor or folks in a hospital has really terrible user experience, sometimes it takes years to master it. Then once people master it, they get used to it, they don't like upgrades, cause then you have to master them again, * in my country you can do a lot of med stuff via email, what they call "encrypted email" - it's not PGP, and it's not encrypted with x509 certs etc You get like an email with a page embedded there that only works on Edge or Chrome, and to "unencrypt it" you need to put like data of birth or something like that.
This market seems really miserable from software/firmware perspective. Happy to ask some more questions.
Famous physician Dr. Abraham Verghese was telling in the freakanomics radio podcast that doctors now a days are behavinv like software professionals by being on their computers and ipads instead of touch the patient and looking for well-known symptoms physically like how doctors used to do.
[1] https://freakonomics.com/podcast/abraham-verghese-thinks-med...
[dead]
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.
The electronic system often benefits complex patients more than someone like you. All your relevant history could fit on a few pages.
But if you have many illnesses, medications, and unclear causes - then having all the data documented and available to different doctors you may see is helpful.
Popular in:
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
As a doctor, I often get asked when I'm going to be replaced by AI, or if AI can help in my work.
The reality is that our work efficiency could have been made so much efficient with a bit of decent user-friendly software that is optimised for the user.
I also love computers and IT, but as a result I understand highly-optimised (usually open source) software.
The proprietary system we have at work is a mess. Inconsistent widgets, some keyboard shortcuts for some dialog boxes, but not for others. Lots of forms that need filling that I shouldn't be having to fill out (it's the same every time but I have to go through the whole process just to speak to a patient over phone).
As others have mentioned here, senior doctors used to look at the patient, and give their opinion. Admin and junior doctors would turn it into action in a safe way, following protocol and prescribing advice to make it happen.
These days senior doctors are checking in their patients themselves, clicking through many menus to order blood tests, checking out their patients, writing their patient letters, and basically sorting out the majority of the admin for enacting what they recommended should happen.
Corporations also set up stuff in rather hostile ways.
I just spent 30 mins searching for the option to create a simple support ticket saying computer hardware on desk X broken.
It’s just layers upon layers of AI agents, help articles, automated systems, voice recognition etc to make it as hard as possible to actually get help from a human
Ha, my whole life. I am a doctor with a CS degree.
There is a fundamental neurological difference and deep mental incompatibility in the "technical" and "medical" way of thinking. You can NEVER be good in both simultaneously. When I am with and think about patients, I cannot use a PC (in the where-is-the-poweron-button way) and when I maintain my little Github projects, I become a dangerous doctor. My ability to change my brain with an "internal mental switch" has improved dramatically, it happens even in minutes.
A great share of my income as a doctor comes from filling medical reports on various online platforms, covering 100000 people which my other five colleagues cannot serve. The platforms are not complex, just online forms that have a lot of copy-pasting and a bunch of clicks and up-downloads. The texts are so similar that I might try to automate/-fill them, most probably with a addon. I imagine they seem awful and scary to them and I don't blame them because it is painful to write a digital medical report and do anything else except... writing.
I mostly choose being in the medical state of mind because there are emergencies I must confront. I do not serve any online project that would need immediate technical intervention -:) <== I am doctor, how do you create a smiling face?
This stood out to me:
> Indeed, the computer, by virtue of its brittle nature, seems to require that it come first. Brittleness is the inability of a system to cope with surprises, and, as we apply computers to situations that are ever more interconnected and layered, our systems are confounded by ever more surprises. By contrast, the systems theorist David Woods notes, human beings are designed to handle surprises. We’re resilient; we evolved to handle the shifting variety of a world where events routinely fall outside the boundaries of expectation. As a result, it’s the people inside organizations, not the machines, who must improvise in the face of unanticipated events.
In this new age of AI, maybe we can start to reverse this trend? Make systems that can adapt and handle surprises, instead of pushing all this brittleness onto the humans using the system
Check out this blog for the best summary of why data has hurt medicine and insurance https://yuzu.health/blog/ai-will-not-fix-healthcare-admin.
The company Yuzu is hiring too. Worth reaching out if you care about how to fix this issue.
I wish schools would stick to paper and pencil homework. Getting kids to stay on task using a computer is neigh impossible.
I bet it would be fine if they stuck to Windows 3.1 and MS Word 6, or DOS + Wordperfect 5.1 (with no network connectivity) which was approximately what I used for my homework.
The problem isn't "computers", its the internet, and ads, and the fact that all "modern" stuff is just a thin wrapper around that.
Yeah, it's hard to make them quit horsing around.
I wish they were actively taught how to stay on task instead of being shamed into it.
I mean they're being handed over / bring their own computer / have their phone at hand, and anyway they probably have all of that at home, and will have at work someday.
From that state of affair the best thing to do is to try and give then the tools to best manage and navigate the situation, not yell "stay on task" at them (which is AFAIK basically the only course of action) which is wholly unproductive.
I have been working at Kaiser Permanente for 5 years, and there were a lot of doctors pretty good with technologies. And they struggle with Epic, famous for bad UX as well. One doctor even created special windows application, where they recorded mouse/keyboard activity with Epic, and replay them on single button click. Same as anthropic "Computer Use", but in the traditional code. And it was written by doctor, not IT engineer. Later, I worked at startup that tried to create intelligent hospital bed, able to record patient heartbeat, respiration, movements without special sensors. The technical part was all good, but we failed to sell any such bed to hospitals, only a few to nursing homes. Doctors are conservative, plus anything related to medical requires a lot of certificates and compliances. Finally, we give up and made consumer device out of it - Sleep Numbers "smart bed". Companies who sell software to doctors spend much more efforts to satisfy all requirements, and make a deal. Investment in user interface quality does not make sense because all decisions made regardless of it.
One rarely talked about aspect of this is that doctors - generally speaking - only trust other doctors. They won't buy an EMR system from someone without the necessary "street cred" - however well-designed that system is.
I know of a large EMR software provider that went as far as to hire physicians as salespeople because having doctors talk to other doctors made sales a lot easier for them.
Interesting! I think I ran head into this without realizing it. I prototyped a product for doctors at one point, and trying to even talk to them about it was quite a slog...
Is this really rarely talked about? In any field you have the leaders having to choose who they listen to. Dunning kruger is real, you have to have a way to separate the overconfident ones from the ones with actual clinical knowledge.
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.
There appears to be (almost) no true competition in healthcare, therefore no real incentives to improve productivity. Wages in healthcare rise disproportionately without productivity gains (Baumols disease); why invest in digitalization?
Wages in healthcare have decreased Year-Over-Year relative to inflation since at least the 90's. Productivity has increased in terms of the number of patients seen / day.
I'm not sure where you got this information, but it does not apply to Physician services who have gotten 5% year over year increases in medicare reimbursements.
Physical Therapists? Sure. But the American Medical Association is a fierce lobbyist.
https://www.ama-assn.org/practice-management/medicare-medica...
The AMA is indeed a fierce lobby - just not for physicians. They are widely regarded as a shill for hospital interests rather than doctors or medical professionals.
Competition isn't the only way to hold down wage costs in healthcare. The UK system involves a combination of monopsony and economies of scale. (I make no other claims about the pros and cons!).
[dead]
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.
> On more than one occasion I have just had my doctor literally Google my symptoms.
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.
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).
That’s still way better than being told to take two Panadol and come back in the morning if your symptoms don’t improve. I mean, 99% of the time it’s a seasonal virus and that’s all you could/should do, but 0.1% of the time it’s meningitis and if you don’t go to the ICU then you die.
and so here is the problem of personalised care in a system where you can see upwards of 30 unfamiliar people a day: sometimes patients would rather I look things up, and others hate the idea of me touching any sort of technology in their presence, and it's nigh-impossible to tell which they are until a good way through the interview.
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.
Just replace typing with voice recognition, and you've got the perfect AI doctor already!
Patient talks about symptoms, doctor returns a markdown-formatted prescription. Charge by the number of tokens.
Soon we'll have the holographic doctor as seen in Star Trek Voyager.
Science fiction, particularly space operas, can be dismissive of doctors. Most of the time the "doctor" is just a diagnostic machine that gives miracle meds and maybe 3d prints new body parts.
Maybe it's prophetic: authors saw the writing on the wall and decided a doctor is a glorified mechanic who works on the most boring machine around (which hasn't changed in 100k years). Or maybe authors just decide the space was better filled by an ex-space-ninja or similar.
probably because doctors work with humans and computers are not humans.
My personal feeling is that medical practices have not evovled too fast with computing. Electrical engineering, mechanical engineering, biomedical engineering etc all contributed a lot to how doctors treat diseases. But whether medical records are digitialized or not is not significant. It helps, but does not increase cure rate. Old fashioned doctors have good reasons to reject. But they do not say no to new medicine, new devices, new procedures.
> My personal feeling is that medical practices have not evovled too fast with computing.
You should see "computing". Resizing a window in Windows has become a lost battle. Working with files on Android is a torture. I really hope that "medical practices" will not "evolve", like "computing" has.
I fully reject your statement about not digitizing being insignificant. And there are several reasons for it, but the main one in my mind is about prevention vs curing.
In an ideal world where every medical record is digitized it would be possible to discover long term causal effects that nowadays we don't know because running long term studies is hard, costly, and in a world where publishing is everything they don't lend to it. So we explored and confirmed only the most obvious long term cause-effect connections.
Therefore, it would enable prevention of some diseases for which we, nowadays, can only have a reactive MO.
Numerous companies have already tried and failed with this approach to medical research. Naively you might think that you could just suck in huge quantities of de-identified patient charts to find all sorts of useful correlations between diagnoses, treatments, and outcomes. But this doesn't actually work because the data quality is so bad: garbage in, garbage out. Doing useful medical research usually requires setting up strict protocols for data entry and patient follow-up.
> it would be possible to discover long term causal effects that nowadays we don't know because running long term studies is hard,
Companies sell the data to ad companies, before any meaningful research can be done.
Fair, but I said "in an ideal world". Also, not sure if selling ads is more profitable to a product like a supplement because mining the digitized medical records showed that (example I pulled out of thin air) "constantly low potassium increases Alzheimer incidence by 50%" or similar.
Ehh, I think there’s a pretty consistent pattern of doctors rejecting pretty basic technologies or procedures that lead to positive outcomes for patients if it’s seeking to address the fact that doctors are human beings that can make mistakes. Medicine is a field full of massive egos.
Yeah I mean let's keep in mind that the man who found hand washing stopped patients dying of infections was roundly ignored [1] for too long.
[1] https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis
Don't pity or excuse the doctors, they're smart and they know what they are doing. If their workflows with computers don't work, it's only because they make more money from this situation.
> If their workflows with computers don't work, it's only because they make more money from this situation.
Or because the workflows do not fit the situation.
Do you think every doctor is their own boss?