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They also fought it because they didn't go to medical school and survive residency to fill out forms all damn day—and they didn't used to have to, they had staf
by yamtaddle 4y ago
They also fought it because they didn't go to medical school and survive residency to fill out forms all damn day—and they didn't used to have to, they had staff for that.
Then the computerized systems "replaced" that staff but all that really means is they cut the human time needed low enough that full-time workers weren't needed, but didn't eliminate it, so now that's another thing doctors have to do themselves.
AFAI can tell, the effect of tech overall is to cut some jobs while making the remaining ones harder and more stressful, while increasing so-called context switching.
- t-writescode 4y agoSounds like modern startup devops-without-devops culture
- throwaway5959 4y agoShift left amirite? Same with DBAs.
- lamontcg 4y agoDon't need DBAs if you're hiring 10x full stack developers.
- nradov 4y agoSome healthcare provider organizations now employ medical scribes who follow physicians around and do all their EHR data entry. This is expensive, but can be cost effective because then the physicians have more time to perform billable procedures.
- yamtaddle 4y agoIf so, that's hilarious, because that's precisely one of the jobs all these expensive, painful-to-use computer systems were supposed to replace. You'd take a year or two course at junior college, to learn shorthand and drill some medical terminology so you'd be less likely to make a bunch of simple transcription mistakes, then go to work.
- nradov 4y agoThere's still a fairly large job market for medical transcriptionists, but that's a different job than being a medical scribe. Transcriptionists don't use shorthand any more, they mostly work from digital voice recordings. And they're typically not transcribing from scratch; now usually a voice recognition system does the first pass and then the human edits it to fix the ~2% errors. Transcriptionists don't usually work directly in EHRs, but their documents are fed into EHRs.
- robertlagrant 4y agoMicrosoft recently bought Nuance for this very reason.
- TeMPOraL 4y agoIt's doubly hilarious when you realize it's the inverse of what the office productivity software did to everyone. Remind me again why do I have to manage my own meetings and prepare so many powerpoints and fill in so many forms as a... well, my position doesn't matter, because everyone is doing the same, no matter their role?
- warbler73 4y agoThe least capable doctor's time is worth $300/hr. The scribe is paid what, $25/hr? This is so much like hearing of engineers that will not hire a $20/hr maid due to egalitarian reasons so they squat in filth or waste all their free hours cleaning, all while capable and willing cleaners starve. Insane.
- dzhiurgis 4y agoAny competent engineer should at least have a maid, driver, nanny, servant, chef, gardener, pool cleaner, a mistress, dog walker and personal assistant /s
- dfadsadsf 4y agoYou are overestimating how much least capable doctor makes (more like 100-150k) and underestimating how much somebody who can type medical information makes (more like $30-$35).
- sicp-enjoyer 4y agoPersonal hours are not fungible. You can't replace a bit of cleaning time throughout the week with an additional $600. Also there are plenty of costs to employing others besides the hourly cost. Large organizations have huge fixed costs to cover them. Consider: - liability - maintaining of knowledge and training to hire help - skill to source and hire people
- Eleison23 4y agoI live below the poverty level. I receive Section 8 funds for housing. The Section 8 inspections and quality standards are so important to me that I hire a cleaning service about 6 times a year to make sure everything in here is spotless, because I'm really not that psychologically or physically capable of cleaning everything, even if I had limitless free time to do it. The maids cost about $130 a visit and they're worth their weight in gold, just so I have peace of mind and a consistently clean place to live. The City thanks me for it, too.
- P_I_Staker 4y ago
- drewbeck 4y agoAh this is great to hear. I been thinking about this approach for a while. Great to hear it’s a Thing.
- ameister14 4y agoThat and the staff actually doubled over the same period
- Scoundreller 4y agoSeems an artefact of doctors not being employees. If their employment status was the same as everyone else’s, there wouldn’t be any effort to replace admin staff with someone getting paid 10x as much unless there was actually a 90% reduction in work (doubtful).
- onlyrealcuzzo 4y agoYou can reduce 90% of the work - but if the remaining 10% is shifted to someone that gets paid 50x as much, it's still a loss.
- Dylan16807 4y agoI, yes, that was their point. You're just saying the same thing with different numbers.
- mattkrause 4y agoLaughs from academia....
- Scoundreller 4y agoTrick is to be hourly!
- hinkley 4y ago> they cut the human time needed low enough that full-time workers weren't needed No, that's not it at all. What GP is saying is that they cut the human expertise low enough that full-time workers weren't needed. The manpower savings never materialized because an app built for experts is faster than one built for casual users, and also because those experts, even with the high training cost, were ultimately cheaper per hour than the highly compensated people who now have to do the job because we 'made it easy'. First you devalue those experts by making their job harder, then you get rid of the job and make it someone else's, split between entry level staff and your most expensive employees. > AFAI can tell, the effect of tech overall is to cut some jobs while making the remaining ones harder and more stressful, while increasing so-called context switching. You still got there in the end.
- StillBored 4y agoBut the doctors almost always were taking notes anyway. My step father (A doctor) fought a losing battle against electronic records because he had _decades_ of paper records stored in the "records" room of his office. That was largely the responsibility of the front desk to pull the patients records and have them ready for him to read/check before seeing the patient. Then clean them up and refile them. Long term patients had pages and pages of hand written notes, prescription histories, etc. So a part of the job has always been the record keeping, OTOH, as one of the other users mentioned, I've seen enough Dr's using their computer records systems to know that software is mostly garbage. The Dr's spend 2-4x the time dealing with the shitty UI as actually typing in the notes now. (In the end he basically retired instead of convert to electronic records).
- covidiot5 4y agoThey’re taking notes with cheap pencils and paper! We should sell them an complex, messy to build, fleet of machines! It’s like cutting off a head when stitching a cut on the leg was the problem.
- toss1 4y agoSounds about right For those that seemed to transfer successfully, I noted that at Mayo Clinic, the doctors use live dictation software and dictate at least some of their notes into the system while the patient is present near the end. This immediate review sometimes brings up a few new questions (from either Dr or patient), and a bit more notetaking. So, it looks like a very efficient system. They also have no apparent shortage of staff organizing things. That said, I doubt every medical organization and office has the same quality setup as a top world-class institution. At some level of degradation, the system becomes more of a hindrance than a help, and that point is likely fairly near the top levels (so most of it is a hindrance).
- bombcar 4y agoDictating while the patient is there is brilliant, because it double-checks both the doctor and the patient's understanding of what happened.
- TeMPOraL 4y ago> AFAI can tell, the effect of tech overall is to cut some jobs while making the remaining ones harder and more stressful, while increasing so-called context switching. 100% agree. The Office suite is, in some ways, the worst thing that happened to corporations. Thanks to computers, everyone can now easily write a report, fill in a spreadsheet, or manage their meetings. Which means that everyone now has to write reports, fill in spreadsheets and manage their calendars. This used to be a separate job. You had people specializing in those tasks, and they were focused and efficient at it. Now, everyone does it on their own, and not only we suck at this, it's also distracting us from the "main" job we're supposed to be doing. The older I get, the more I feel computer revolution was in big part a bait-and-switch.
- chiefalchemist 4y agoGreat point(s). There's no longer the barrier to entry. No longer a belief that just because you can doesn't mean you should. That behaviour gets reinforced because doing X or Y is easy, that lack of friction builds a bias that the end product / output is 10x better than it really is. You're not the only one with that bait and switch feeling.