11 ms·

Why doctors hate their computers (2018)

121 points by mitchbob 1y ago

mitchbob 1y ago
https://archive.ph/PlnQl 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.
- tinix 1y ago
  Deja vu... https://news.ycombinator.com/item?id=44778004 https://news.ycombinator.com/item?id=44778004
deleted 1y ago
[deleted]
gnabgib 1y ago
Popular in: 2023 (100 points, 116 comments) https://news.ycombinator.com/item?id=36903220 https://news.ycombinator.com/item?id=36903220 2020 (279 points, 319 comments) https://news.ycombinator.com/item?id=24336039 https://news.ycombinator.com/item?id=24336039 2018 (157 points, 109 comments) https://news.ycombinator.com/item?id=18381969 https://news.ycombinator.com/item?id=18381969
johntfella 1y ago
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.
- MathMonkeyMan 1y ago
  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.
  - johntfella 1y ago
    to quote Wendell Berry, “the more superficial and unsatisfying our lives become, the faster we need to progress"
  - vjvjvjvjghv 1y ago
    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.
  - hibikir 1y ago
    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.
  - hulitu 1y ago
    > 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.
  - acomjean 1y ago
    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.
donatj 1y ago
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.
- kijin 1y ago
  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.
  - SoftTalker 1y ago
    Soon we'll have the holographic doctor as seen in Star Trek Voyager.
    - dguest 1y ago
      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.
- Scoundreller 1y ago
  > 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.
  - abhisuri97 1y ago
    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).
dekhn 1y ago
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.
- shigawire 1y ago
  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.
zabzonk 1y ago
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.
golem14 1y ago
I wish schools would stick to paper and pencil homework. Getting kids to stay on task using a computer is neigh impossible.
- CamperBob2 1y ago
  Yeah, it's hard to make them quit horsing around.
  - lloeki 1y ago
    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.
- tacostakohashi 1y ago
  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.
ljchen 1y ago
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.
- catgary 1y ago
  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.
  - XorNot 1y ago
    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 https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis
  - deleted 1y ago
    [deleted]
- marcyb5st 1y ago
  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.
  - 1y ago
jayd16 1y ago
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.
- sfn42 1y ago
  I'd order birthday cakes daily just to prove a point
  - Y_Y 1y ago
    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.
    - somecontext 1y ago
      Here's a reference, as well as other options: https://worldgo.ca/understanding-your-airlines-meal-options/ https://worldgo.ca/understanding-your-airlines-meal-options/
  - dotancohen 1y ago
    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.
    - bboygravity 1y ago
      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.
davnn 1y ago
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?
- manmathmo 1y ago
  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!).
- the_d3f4ult 1y ago
  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.
  - resource_waste 1y ago
    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_d3f4ult 1y ago
      https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-pay-has-plummeted-2001-find-out-why 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.
- deleted 1y ago
  [deleted]
lifestyleguru 1y ago
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.
- anonymars 1y ago
  Do you think every doctor is their own boss?
- hulitu 1y ago
  > 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.
russellpekala 1y ago
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 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.
anon_cow1111 1y ago
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.
- gloxkiqcza 1y ago
  It’s even more concerning you obtained access to this system with ease. Sounds like a pretty serious security incident.
- lqet 1y ago
  Wait - you accessed your doctor's computer after he left the room and downloaded data from it?
  - amelius 1y ago
    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."
  - teekert 1y ago
    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...
    - zbentley 1y ago
      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.
Havoc 1y ago
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
makach 1y ago
probably because doctors work with humans and computers are not humans.
Abishek_Muthian 1y ago
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-medicine-can-do-better-update/ https://freakonomics.com/podcast/abraham-verghese-thinks-med...
- JohnClark1337 1y ago
  [dead]
dm319 1y ago
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.
cainxinth 1y ago
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.
- cyberpunk 1y ago
  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.
  - Knork-and-Fife 1y ago
    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.
  - Merad 1y ago
    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.
BjoernKW 1y ago
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.
- freedomben 1y ago
  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...
- itisokqqq 1y ago
  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.
tsoukase 1y ago
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?
JayShower 1y ago
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
alexsmirnov 1y ago
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.
alfanick 1y ago
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.
Morgananji147 1y ago
[dead]

121 points by mitchbob 1y ago

https://archive.ph/PlnQl 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.

tinix 1y ago
Deja vu... https://news.ycombinator.com/item?id=44778004 https://news.ycombinator.com/item?id=44778004

deleted 1y ago

[deleted]

gnabgib 1y ago

Popular in: 2023 (100 points, 116 comments) https://news.ycombinator.com/item?id=36903220 https://news.ycombinator.com/item?id=36903220 2020 (279 points, 319 comments) https://news.ycombinator.com/item?id=24336039 https://news.ycombinator.com/item?id=24336039 2018 (157 points, 109 comments) https://news.ycombinator.com/item?id=18381969 https://news.ycombinator.com/item?id=18381969

johntfella 1y ago

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.

MathMonkeyMan 1y ago
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.
- johntfella 1y ago
  to quote Wendell Berry, “the more superficial and unsatisfying our lives become, the faster we need to progress"
- vjvjvjvjghv 1y ago
  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.
- hibikir 1y ago
  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.
- hulitu 1y ago
  > 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.
- acomjean 1y ago
  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.

donatj 1y ago

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.

kijin 1y ago
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.
- SoftTalker 1y ago
  Soon we'll have the holographic doctor as seen in Star Trek Voyager.
  - dguest 1y ago
    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.
Scoundreller 1y ago
> 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.
- abhisuri97 1y ago
  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).

dekhn 1y ago

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.

shigawire 1y ago
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.

zabzonk 1y ago

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.

golem14 1y ago

I wish schools would stick to paper and pencil homework. Getting kids to stay on task using a computer is neigh impossible.

CamperBob2 1y ago
Yeah, it's hard to make them quit horsing around.
- lloeki 1y ago
  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.
tacostakohashi 1y ago
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.

ljchen 1y ago

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.

catgary 1y ago
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.
- XorNot 1y ago
  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 https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis
- deleted 1y ago
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marcyb5st 1y ago
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.
- 1y ago

jayd16 1y ago

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.

sfn42 1y ago
I'd order birthday cakes daily just to prove a point
- Y_Y 1y ago
  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.
  - somecontext 1y ago
    Here's a reference, as well as other options: https://worldgo.ca/understanding-your-airlines-meal-options/ https://worldgo.ca/understanding-your-airlines-meal-options/
- dotancohen 1y ago
  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.
  - bboygravity 1y ago
    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.

davnn 1y ago

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?

manmathmo 1y ago
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!).
the_d3f4ult 1y ago
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.
- resource_waste 1y ago
  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_d3f4ult 1y ago
    https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-pay-has-plummeted-2001-find-out-why 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.
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lifestyleguru 1y ago

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.

anonymars 1y ago
Do you think every doctor is their own boss?
hulitu 1y ago
> 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.

russellpekala 1y ago

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 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.

anon_cow1111 1y ago

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.

gloxkiqcza 1y ago
It’s even more concerning you obtained access to this system with ease. Sounds like a pretty serious security incident.
lqet 1y ago
Wait - you accessed your doctor's computer after he left the room and downloaded data from it?
- amelius 1y ago
  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."
- teekert 1y ago
  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...
  - zbentley 1y ago
    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.

Havoc 1y ago

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

makach 1y ago

probably because doctors work with humans and computers are not humans.

Abishek_Muthian 1y ago

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-medicine-can-do-better-update/ https://freakonomics.com/podcast/abraham-verghese-thinks-med...

JohnClark1337 1y ago
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dm319 1y ago

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.

cainxinth 1y ago

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.

cyberpunk 1y ago
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.
- Knork-and-Fife 1y ago
  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.
- Merad 1y ago
  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.

BjoernKW 1y ago

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.

freedomben 1y ago
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...
itisokqqq 1y ago
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.

tsoukase 1y ago

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?

JayShower 1y ago

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

alexsmirnov 1y ago

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.

alfanick 1y ago

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.

Morgananji147 1y ago

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