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Oh great, I come to HN for tech news and see this. As a graduating medical student doing a surgical prelim, I'm certainly not looking forward to 28 hour work da

Oh great, I come to HN for tech news and see this. As a graduating medical student doing a surgical prelim, I'm certainly not looking forward to 28 hour work days. I think what many don't realize is that day-to-day medicine is super low-tech. The ACGME is still acting off a model where sign-outs are face-to-face following a checklist (see: https://www.ncbi.nlm.nih.gov/books/NBK43722/ https://www.ncbi.nlm.nih.gov/books/NBK43722/). This is the best we've come up with, and it frankly takes a lot of time. It's no wonder 16 hours didn't cut it. What we need is a better way to do sign-outs so that residents can know what's going on even during their days off. The very wording "sign-out" is rather a misnomer. Just because you're leaving the hospital for two days doesn't mean you forget about your patients. What we need is something like a Twitter feed so you can get updates on your patients when you're not in the hospital. Then you wouldn't have to have a full-blown sign-out when you return.

brianwawok 10y ago
Do you really want to work a long day and then be barraged by questions and data on your offtime? Seems like sign out us a reasonable way to prevent burnout.
- thesmallestcat 10y ago
  > work a long day and then be barraged by questions and data on your offtime Sounds a lot like "dev-ops."
- pharrington 10y ago
  He's proposing an alternative to the current reality where medical residents literally do not have offtime. The burnout is happening right now, because the current "solution" to tracking patients' updates is to store all of that information in human beings.
aswanson 10y ago
That Twitter feed sounds like a start up opportunity. Would it be easy to maneuver around hippa?
- FLUX-YOU 10y ago
  HIPAA's probably the least of your concerns. Any feed like that would have to integrate with whatever EMR/Surgery information/Scheduling/HL7 Interface solution(s) your hospital uses, none of which are the same or even remotely resemble each other. Your system would become yet-another-password to remember unless hospital IT would be willing to let you join the domain or group, which likely means you'd need to support on-prem installations.
  - vertex-four 10y ago
    Do most hospitals not have an ADFS instance floating about somewhere?
    - chimeracoder 10y ago
      > Do most hospitals not have an ADFS instance floating about somewhere? Good luck getting all of the signoff and political buy-in required to get set up with that. You could spend 18 months running around to convince someone to do ten minutes of work to bring you online, and I'm not exaggerating.
- mrcactu5 10y ago
  don't you mean work with hippa?
- pharrington 10y ago
  In the tech support world, customer hand off is essentially a solved problem - they use ticket systems. Yes, alot of the software used is in-house developed trash, and alot of companies (Comcast is probably the best known example of this) are full-on negligent in regards to training support techs, but again, we know how to, and in many places do, do way better.
jseliger 10y ago
As a graduating medical student doing a surgical prelim, I'm certainly not looking forward to 28 hour work days. I think what many don't realize is that day-to-day medicine is super low-tech. It's too late for you, but I wrote an essay called "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...) to warn people about what med school and residency is really like—and to tell them that there are good alternatives! Living with someone who went through the process led me to write the essay.
- notMD311 10y ago
  I think your essay raises a lot of points about life until 40 but doesn't talk about what comes afterwards. You don't point out one reason some people choose nursing/PA school. They get to move between fields somewhat easily. I think that belies the difference between these professions and physicians; the doctors become specialized in their areas while the mid level providers carry out their plans. For people who have been in the hospital, the best argument to being a doctor over PA/nurse/etc is that, at age 60, you could be teaching, seeing patients, doing research, building biomedical devices, conducting community outreach, and doing what you were trained to do. Notably, for doctors, that doesn't include dealing with bodily fluids, angry family members, an arrogant boss 30 years younger, etc. Like in every profession, doctors need to work to get paid. But, if you want to be in charge of your own work day when you're at the middle to end of your career, be a doctor.

brianwawok 10y ago

Do you really want to work a long day and then be barraged by questions and data on your offtime? Seems like sign out us a reasonable way to prevent burnout.

thesmallestcat 10y ago
> work a long day and then be barraged by questions and data on your offtime Sounds a lot like "dev-ops."
pharrington 10y ago
He's proposing an alternative to the current reality where medical residents literally do not have offtime. The burnout is happening right now, because the current "solution" to tracking patients' updates is to store all of that information in human beings.

aswanson 10y ago

That Twitter feed sounds like a start up opportunity. Would it be easy to maneuver around hippa?

FLUX-YOU 10y ago
HIPAA's probably the least of your concerns. Any feed like that would have to integrate with whatever EMR/Surgery information/Scheduling/HL7 Interface solution(s) your hospital uses, none of which are the same or even remotely resemble each other. Your system would become yet-another-password to remember unless hospital IT would be willing to let you join the domain or group, which likely means you'd need to support on-prem installations.
- vertex-four 10y ago
  Do most hospitals not have an ADFS instance floating about somewhere?
  - chimeracoder 10y ago
    > Do most hospitals not have an ADFS instance floating about somewhere? Good luck getting all of the signoff and political buy-in required to get set up with that. You could spend 18 months running around to convince someone to do ten minutes of work to bring you online, and I'm not exaggerating.
mrcactu5 10y ago
don't you mean work with hippa?
pharrington 10y ago
In the tech support world, customer hand off is essentially a solved problem - they use ticket systems. Yes, alot of the software used is in-house developed trash, and alot of companies (Comcast is probably the best known example of this) are full-on negligent in regards to training support techs, but again, we know how to, and in many places do, do way better.

jseliger 10y ago

As a graduating medical student doing a surgical prelim, I'm certainly not looking forward to 28 hour work days. I think what many don't realize is that day-to-day medicine is super low-tech. It's too late for you, but I wrote an essay called "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...) to warn people about what med school and residency is really like—and to tell them that there are good alternatives! Living with someone who went through the process led me to write the essay.

notMD311 10y ago
I think your essay raises a lot of points about life until 40 but doesn't talk about what comes afterwards. You don't point out one reason some people choose nursing/PA school. They get to move between fields somewhat easily. I think that belies the difference between these professions and physicians; the doctors become specialized in their areas while the mid level providers carry out their plans. For people who have been in the hospital, the best argument to being a doctor over PA/nurse/etc is that, at age 60, you could be teaching, seeing patients, doing research, building biomedical devices, conducting community outreach, and doing what you were trained to do. Notably, for doctors, that doesn't include dealing with bodily fluids, angry family members, an arrogant boss 30 years younger, etc. Like in every profession, doctors need to work to get paid. But, if you want to be in charge of your own work day when you're at the middle to end of your career, be a doctor.