4 ms·

It’s not relearning but making sure you get the facts from a primary source. The ICU motto is ‘trust no bastard’ - if you rely on what is written down without a

It’s not relearning but making sure you get the facts from a primary source. The ICU motto is ‘trust no bastard’ - if you rely on what is written down without asking the patient directly, can you be sure that it is correct? I have personally come across many instances where what has been recorded is inaccurate or misses important details that careful questioning elicits. I will always take my own history from a patient, but I use the previous records as corroborating records - I know what the general gist has been, but what might they have missed/what might the patient have told them? It is a critical part of good patient care, despite its inefficiencies

k__ 9y ago
lol, I was once in the hospital because I hit my head. I had a panic attack at university, hyperventilated and passed out. They asked me what happend and wrote down "was drunk" so everyone I met at the hospital was like "uhuu was drunk at the uni... one of those guys..."
andreygrehov 9y ago
Well, that's because the underlying approach needs an improvement. As an example, imagine that every doctor-patient communication is recorded with a camera. Now all you need to do to get facts from a primary source is to watch a video with another doctor talking to a patient. I'm not saying that this is the solution, but options do exist and they are worth exploration.
- YeGoblynQueenne 9y ago
  Say you're a gastroenterologist and in the video, your patient was interviewed by a pathologist. The pathologist would ask pathologist questions, but you need to know gastroenterologist answers. How do you get them from the video of a pathologist asking pathologist questions?
  - andreygrehov 9y ago
    In this case gastroenterologist goes to a patient and asks questions he is interested in. The point is that a patient doesn't have to tell the same story over and over again. The problem is that gastroenterologist would now have to have its own video, which would probably be time-consuming for the third doc.
    - robbiep 9y ago
      Patients report higher satisfaction with their medical care the longer that they spend engaging with clinicians. Even if this was a practical solution, by deploying cameras and ensuring that the resulting files were accessible and categorised simply and easily (no easy IT solution!) it doesn't change the fact that by reducing the amount of time a doctor (any doctor) spends with patients is going to worsen their outocmes, even if they are self-reported. Anyway, we already spend far too much time not with patients. And how is this any different from reading a 'transcript' of the last interaction a patient had with a Doctor [0] https://www.fiercehealthcare.com/it/study-docs-spend-more-time-computers-than-patients https://www.fiercehealthcare.com/it/study-docs-spend-more-ti...
      - mgkimsal 9y ago
        > And how is this any different from reading a 'transcript' of the last interaction a patient had with a Doctor watching body language, pauses, etc vs just reading can give different information. and multiple people reviewing that over a spell will yield different/new/conflicting insights. but it's different than reading a transcript.
      - andreygrehov 9y ago
        > Patients report higher satisfaction with their medical care the longer that they spend engaging with clinicians. Agreed. But that is because doctors are not easily accessible. You can't simply call doctor's cell phone or text him a message. Instead, you call the office, leave a message and wait for God knows how long. Some doctors do not even bother to call you back if they're not in the office. > And how is this any different from reading a 'transcript' of the last interaction a patient had with a Doctor You don't want to cancel the transcript-based approach. I was talking about improving existing processes, not replacing them altogether. Knowing that you're being recorded makes you more responsible for every note you take, it improves the kind of information doctors write down. I'm sure you are aware that there are a ton of things to improve in the healthcare industry. It's just a matter of wise execution, which is the most complicated part.
microcolonel 9y ago
Can confirm that basic details frequently get misrecorded (here in Toronto). At a recent visit, the surgical staff received such a broken telephone version of my original reports and activity in the hospital, that when I overheard the surgeon discussing with the students prior to the procedure I literally burst out laughing (despite having an appendicitis waiting to be removed). This is just how records like this work, frequently contextually or globally incorrect, I don't think it's really a matter of malpractice, at least not in relative terms; though I guess they could do better, like recording that staff had witnessed me collapse (!) two times (one in the waiting room, one in the halls) before they left me sitting in some random chair in a hallway for a couple hours, during which time I passed out a third time, scaring the bejesus out of the others waiting there, none of whom were patients. Hospitals aren't really all that great at paying attention anywhere, as far as I can tell; the U.S. has the most discerning customers (and to some extent, some of the last remaining customers in the developed world). In the U.S. you might have some hope of complaining about service like I received, for example how the triage nurse spilled what looked like about 200ml of my blood all over my arm and the floor while drawing a sample at intake, or that when somebody finally called me to the the first room, she didn't even wait for me to get to the locked door (which I failed to do, because I collapsed half way there and needed to be wheeled in, mostly helped by random bystanders) before turning and walking back to sit down behind the desk (not at the desk), where I saw her playing on her phone.
- creep 9y ago
  I was at the hospital with a kidney infection last month. I get these regularly. I knew it was a kidney infection. I described my symptoms and the intake nurse agreed it sounded like a kidney infection. I told them my heart rate was faster than normal-- it's usually at 73, but it was now at 100. They took my vitals, which showed a fast heart rate (110) but I watched the nurse record a normal heart rate. Okay, whatever, maybe they think I'm anxious. They take my urine, and three hours later they tell me my urine sample was "pristine". They were amazed at how clean it looked. Not even a single protein-- and as a female with a vagina that often discharges a proteinous substance, this was surprising! (And very good news! Doctor was astounded). The doctor concluded my kidney pain was "mechanical", that the muscle in that area had been bruised somehow I told her this was not the case, but she discharged me. 16 hours later (at home now) I'm running a fever of 104. My resting heart rate is an astounding 132 bpm. I'm scared of sepsis (infection of the blood) since I have experienced that before from kidney infections. I go to the hospital preparing for another 5 hour waiting time, but luckily they get me in an intake bed right away. I'm covering myself with a heavy blanket in my fever state-- something one shouldn't do, but nobody took it off me until I was about to be discharged. They come back with the results from another urine sample, and surprise, I have a kidney infection! I asked the doctor why my urine was "pristine" the day before and he said, "the lab tech probably didn't keep the dip stick in long enough" (which is why the test didn't register any protein in my urine whatsoever...) He acted like it was no big deal, like it happened all the time. They gave me 1/4 dose of morphine for the headache because I "look to be about 100 pounds" (I'm 5'10". That would put me at a BMI of 14.5-- ie. severely underweight, and cause for medical concern in and of itself! I'm 135 pounds, with a BMI of 19.4 Honestly, what the hell.) which doesn't help the pain at all, and I'm still wrapped in what amounts to a sweat lodge-- once again, nobody told me to take the blanket off. This is very common knowledge, but in my state of high fever and pain I did not think that it could be a bad idea. I would expect the doctors and nurses to be aware. An hour later they suddenly tell me to get out of bed and they will move me to the waiting room with a chair and a goddamn television that I can already hear thumping through the walls, because this is an intake bed and "other patients need it". I'm sure they do, but I literally can't walk right now. Long story short, the next time I get a kidney infection I'm staying home to die. The lack of care in that situation was astounding. To top it off, they treated me like a bad patient after I protested being moved to the waiting room. edit: I also forgot to mention that they were going to give me pill antibiotics at discharge. I suggested they give me an IV instead, and set me up at an IV clinic. I'm not kidding, they said, "oh! That's actually a great idea". Ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh
Griffinsauce 9y ago
This is a perfect example of the problem with uneducated opinions about healthcare. Everybody has them, has never even tried to confirm their assumptions with a doctor and will continue to propose all sorts of fixes (see sibling comments) that make zero practical sense and will actually drastically reduce the quality of care. My SO is a doctor, even here in Europe there are many flaws, but what I have learned over the years is that this system is way, way more complex and effective than people think. If you want to improve it, great! Step one: go talk to a doctor about your ideas. If you haven't done that, don't spread your unfounded assumptions, it only leads to more demonization of staff and systems and doesn't help anybody.

k__ 9y ago

lol, I was once in the hospital because I hit my head. I had a panic attack at university, hyperventilated and passed out. They asked me what happend and wrote down "was drunk" so everyone I met at the hospital was like "uhuu was drunk at the uni... one of those guys..."

andreygrehov 9y ago

Well, that's because the underlying approach needs an improvement. As an example, imagine that every doctor-patient communication is recorded with a camera. Now all you need to do to get facts from a primary source is to watch a video with another doctor talking to a patient. I'm not saying that this is the solution, but options do exist and they are worth exploration.

YeGoblynQueenne 9y ago
Say you're a gastroenterologist and in the video, your patient was interviewed by a pathologist. The pathologist would ask pathologist questions, but you need to know gastroenterologist answers. How do you get them from the video of a pathologist asking pathologist questions?
- andreygrehov 9y ago
  In this case gastroenterologist goes to a patient and asks questions he is interested in. The point is that a patient doesn't have to tell the same story over and over again. The problem is that gastroenterologist would now have to have its own video, which would probably be time-consuming for the third doc.
  - robbiep 9y ago
    Patients report higher satisfaction with their medical care the longer that they spend engaging with clinicians. Even if this was a practical solution, by deploying cameras and ensuring that the resulting files were accessible and categorised simply and easily (no easy IT solution!) it doesn't change the fact that by reducing the amount of time a doctor (any doctor) spends with patients is going to worsen their outocmes, even if they are self-reported. Anyway, we already spend far too much time not with patients. And how is this any different from reading a 'transcript' of the last interaction a patient had with a Doctor [0] https://www.fiercehealthcare.com/it/study-docs-spend-more-time-computers-than-patients https://www.fiercehealthcare.com/it/study-docs-spend-more-ti...
    - mgkimsal 9y ago
      > And how is this any different from reading a 'transcript' of the last interaction a patient had with a Doctor watching body language, pauses, etc vs just reading can give different information. and multiple people reviewing that over a spell will yield different/new/conflicting insights. but it's different than reading a transcript.
    - andreygrehov 9y ago
      > Patients report higher satisfaction with their medical care the longer that they spend engaging with clinicians. Agreed. But that is because doctors are not easily accessible. You can't simply call doctor's cell phone or text him a message. Instead, you call the office, leave a message and wait for God knows how long. Some doctors do not even bother to call you back if they're not in the office. > And how is this any different from reading a 'transcript' of the last interaction a patient had with a Doctor You don't want to cancel the transcript-based approach. I was talking about improving existing processes, not replacing them altogether. Knowing that you're being recorded makes you more responsible for every note you take, it improves the kind of information doctors write down. I'm sure you are aware that there are a ton of things to improve in the healthcare industry. It's just a matter of wise execution, which is the most complicated part.

microcolonel 9y ago

Can confirm that basic details frequently get misrecorded (here in Toronto). At a recent visit, the surgical staff received such a broken telephone version of my original reports and activity in the hospital, that when I overheard the surgeon discussing with the students prior to the procedure I literally burst out laughing (despite having an appendicitis waiting to be removed). This is just how records like this work, frequently contextually or globally incorrect, I don't think it's really a matter of malpractice, at least not in relative terms; though I guess they could do better, like recording that staff had witnessed me collapse (!) two times (one in the waiting room, one in the halls) before they left me sitting in some random chair in a hallway for a couple hours, during which time I passed out a third time, scaring the bejesus out of the others waiting there, none of whom were patients. Hospitals aren't really all that great at paying attention anywhere, as far as I can tell; the U.S. has the most discerning customers (and to some extent, some of the last remaining customers in the developed world). In the U.S. you might have some hope of complaining about service like I received, for example how the triage nurse spilled what looked like about 200ml of my blood all over my arm and the floor while drawing a sample at intake, or that when somebody finally called me to the the first room, she didn't even wait for me to get to the locked door (which I failed to do, because I collapsed half way there and needed to be wheeled in, mostly helped by random bystanders) before turning and walking back to sit down behind the desk (not at the desk), where I saw her playing on her phone.

creep 9y ago
I was at the hospital with a kidney infection last month. I get these regularly. I knew it was a kidney infection. I described my symptoms and the intake nurse agreed it sounded like a kidney infection. I told them my heart rate was faster than normal-- it's usually at 73, but it was now at 100. They took my vitals, which showed a fast heart rate (110) but I watched the nurse record a normal heart rate. Okay, whatever, maybe they think I'm anxious. They take my urine, and three hours later they tell me my urine sample was "pristine". They were amazed at how clean it looked. Not even a single protein-- and as a female with a vagina that often discharges a proteinous substance, this was surprising! (And very good news! Doctor was astounded). The doctor concluded my kidney pain was "mechanical", that the muscle in that area had been bruised somehow I told her this was not the case, but she discharged me. 16 hours later (at home now) I'm running a fever of 104. My resting heart rate is an astounding 132 bpm. I'm scared of sepsis (infection of the blood) since I have experienced that before from kidney infections. I go to the hospital preparing for another 5 hour waiting time, but luckily they get me in an intake bed right away. I'm covering myself with a heavy blanket in my fever state-- something one shouldn't do, but nobody took it off me until I was about to be discharged. They come back with the results from another urine sample, and surprise, I have a kidney infection! I asked the doctor why my urine was "pristine" the day before and he said, "the lab tech probably didn't keep the dip stick in long enough" (which is why the test didn't register any protein in my urine whatsoever...) He acted like it was no big deal, like it happened all the time. They gave me 1/4 dose of morphine for the headache because I "look to be about 100 pounds" (I'm 5'10". That would put me at a BMI of 14.5-- ie. severely underweight, and cause for medical concern in and of itself! I'm 135 pounds, with a BMI of 19.4 Honestly, what the hell.) which doesn't help the pain at all, and I'm still wrapped in what amounts to a sweat lodge-- once again, nobody told me to take the blanket off. This is very common knowledge, but in my state of high fever and pain I did not think that it could be a bad idea. I would expect the doctors and nurses to be aware. An hour later they suddenly tell me to get out of bed and they will move me to the waiting room with a chair and a goddamn television that I can already hear thumping through the walls, because this is an intake bed and "other patients need it". I'm sure they do, but I literally can't walk right now. Long story short, the next time I get a kidney infection I'm staying home to die. The lack of care in that situation was astounding. To top it off, they treated me like a bad patient after I protested being moved to the waiting room. edit: I also forgot to mention that they were going to give me pill antibiotics at discharge. I suggested they give me an IV instead, and set me up at an IV clinic. I'm not kidding, they said, "oh! That's actually a great idea". Ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

Griffinsauce 9y ago

This is a perfect example of the problem with uneducated opinions about healthcare. Everybody has them, has never even tried to confirm their assumptions with a doctor and will continue to propose all sorts of fixes (see sibling comments) that make zero practical sense and will actually drastically reduce the quality of care. My SO is a doctor, even here in Europe there are many flaws, but what I have learned over the years is that this system is way, way more complex and effective than people think. If you want to improve it, great! Step one: go talk to a doctor about your ideas. If you haven't done that, don't spread your unfounded assumptions, it only leads to more demonization of staff and systems and doesn't help anybody.