Technology, Medicine, Communication

[Lazarus]

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Hello,

I was wondering if you all think that, as nontrads with previous careers, will we be better at this issue:

http://www.nytimes.com/2011/02/27/opinion/27verghese.html?src=me&ref=general

The author references the occurence of turning patients into commodities, and that technology is really degrading the personal medicine approach.

I would like to think that with our previous experiences working with people and technology that we will not fall into this pitfall, or at least be more wary of it. I would also like to think that we are more focused on the personal aspects of medicine and building that patient provider bond. But then again maybe I am just a rosy cheeked postbac and that once I am in the grind I will fall into this trap as well.

Anywho I just thought this was interesting and wanted to hear some thoughts on this issue from non-trads.

 

[mauberley]

I feel that though we may be more conscious of such issues, in the end we will largely be the products of our education and training environments.

 

[Pons Asinorum]

I feel that though we may be more conscious of such issues, in the end we will largely be the products of our education and training environments.

Good answer. If your attendings during M3/4 and residency treat patients like commodities, you will most likely treat them the same way. It hurts to think, but you will treat patients in the way that will maximize your evaluations and recommendations for residency/fellowship. There is a lot of institutional inertia that needs to be changed to fix that problem.

 

[EdLongshanks]

I suspect that I will use technology the way I use it now. To speed up unpleasant tasks so that I can spend more time doing what I like to do, which is talk to people and discover things.

The article is describing a trend that is a result of 2 things, neither of which is the result too much technology.

The first is the increase in the number of patients that a doctor treats. This is not caused by technology, and, in fact, is improved by technology. A young doctor spends less of his time scribbling on paper and more time talking into a digital recorder which goes to the transcription department. Even if he writes, he's more likely to type - which is much, much faster - and less error prone.

The second cause of the trend is the increasing numbers-game of medical school applications. In the good-ole boy "get into medical school because my daddy was a doctor" days, the medical schools had many traditional medicine families who were born knowing how to be a Normal Rockwell doctor.

Now we have professionalized med school apps. This has led to more equity in the system, but has also resulted in people who care most about numbers and process. I was shocked in my interviews to discover that the actual interview that I worked so hard for consisted of 20 minutes to (at most) an hour. In my successful interview I sat and listened for at least 10 minutes of that. This system is not designed to bring in personable people who display incredible verbal interaction skills. Instead it recruits people who knew how to find a PS writer, take the best prep course, get the best LOR's, find the most impressive sounding volunteer activities and clinical experience. We are recruiting people who are not, necessarily, interested in people.

 

[Pons Asinorum]

The second cause of the trend is the increasing numbers-game of medical school applications. In the good-ole boy "get into medical school because my daddy was a doctor" days, the medical schools had many traditional medicine families who were born knowing how to be a Normal Rockwell doctor.

Now we have professionalized med school apps. This has led to more equity in the system, but has also resulted in people who care most about numbers and process. I was shocked in my interviews to discover that the actual interview that I worked so hard for consisted of 20 minutes to (at most) an hour. In my successful interview I sat and listened for at least 10 minutes of that. This system is not designed to bring in personable people who display incredible verbal interaction skills. Instead it recruits people who knew how to find a PS writer, take the best prep course, get the best LOR's, find the most impressive sounding volunteer activities and clinical experience. We are recruiting people who are not, necessarily, interested in people.

I'm not in disagreement with much of what you're saying, but I think you are taking liberty with some correlation/causation. Even as the "industry" that profits from medical school admissions has grown, I can't say that you present compelling evidence that that process has anything whatsoever to do with how "interested in people" the current applicant pool is, or that is very much different in that metric from applicants from 30 years ago. Very smart kids have always been steered towards medicine. Those very smart kids have always had a tendency to be little *******s. Not sure what has changed with the people, and I definitely see what has happened with the conditions we throw at them.

 

[BPlaysItCool]

Lazarus. Interesting thread.

There is the hyperbole and mythology of technology at work. One. That it will always save us. Two. That this is progress, inevitable, linear, and always better.

But very few lemmings among us are capable of grasping the Jevons Paradox. That when you increase effiency you increase throughput. Escpecially when demand is constant, ie the need for physciain services.

It is similar to building a highway to relieve congestion only to fill it up again with increased development.

One would have to have been on the ground, working in healthcare, and be perceptive to see what I'm saying in regards to EMR use. Older physicians--at least the one or two rebels I consorted with on a friendly basis, noticed some things about how their work had changed with the advent of the EMR.

Even in my 10 years or so. Everytime some wingnut in a cubicle--god knows wher--comes up a new application for our powerful IT systems it boiled down to a handful of mouseclicks for us per patient. Now. These guys need jobs. So the mouseclicks were ever expanding.

Here's how it worked in the fiendly pediatrics setting. Hi mom, how are you...how's the baby....isn't she cute!.....ok put her up here please. And you've got the forms....great. click. click-click. clickity--click....... for every little peiece of data that pertains to the basic record and then the thousands of other extraneous nonsense that the office people can't wait to get their hands on for some kind of patient satisfaction with the brochure's or some stupid ****....

We have become mouse clicking slaves. Try squeezing in some friendly conversation at your own peril. The time crunch will punch you in the balls for it.

If anything. Our age may make us resent the un-humanity of it more. Because we didn't grow up tweeting about our bowl movements. But the inevitablity of The Machine...crushes all. Old and young alike.

 

[Pons Asinorum]

Man, I saw your avatar and read this and I swear it reads like a jazz riff, the cadence and stream-of-consciousness of it.

Lazarus. Interesting thread.

There is the hyperbole and mythology of technology at work. One. That it will always save us. Two. That this is progress, inevitable, linear, and always better.

But very few lemmings among us are capable of grasping the Jevons Paradox. That when you increase effiency you increase throughput. Escpecially when demand is constant, ie the need for physciain services.

It is similar to building a highway to relieve congestion only to fill it up again with increased development.

One would have to have been on the ground, working in healthcare, and be perceptive to see what I'm saying in regards to EMR use. Older physicians--at least the one or two rebels I consorted with on a friendly basis, noticed some things about how their work had changed with the advent of the EMR.

Even in my 10 years or so. Everytime some wingnut in a cubicle--god knows wher--comes up a new application for our powerful IT systems it boiled down to a handful of mouseclicks for us per patient. Now. These guys need jobs. So the mouseclicks were ever expanding.

Here's how it worked in the fiendly pediatrics setting. Hi mom, how are you...how's the baby....isn't she cute!.....ok put her up here please. And you've got the forms....great. click. click-click. clickity--click....... for every little peiece of data that pertains to the basic record and then the thousands of other extraneous nonsense that the office people can't wait to get their hands on for some kind of patient satisfaction with the brochure's or some stupid ****....

We have become mouse clicking slaves. Try squeezing in some friendly conversation at your own peril. The time crunch will punch you in the balls for it.

If anything. Our age may make us resent the un-humanity of it more. Because we didn't grow up tweeting about our bowl movements. But the inevitablity of The Machine...crushes all. Old and young alike.

 

[Helen Wheels]

I was especially impressed with the author's comment about the importance of the physical exam "ritual." From personal experience for myself and other family members, I really agree with this. Specialists, more so than primary care, barely touch patients anymore. I have often thought at specialist appointments that what happened at the appointment could have been done over the phone. This was esp notable when I was my Mom's caregiver and I had to A) take off work and B) transport a person with limited mobility to the office. I realize you can't bill for that but I really think it would have made me feel like "something was done" for all my effort.

Also, EHRs are great as far as making info accessible, esp between sites. I think it depersonalizes the encounter, though. I have seen a few personal physicians who have been typing the note into the record during the appointment. You might say this is no different from writing with a pen in a chart but it is. To type in the computer they have to turn away from the patient and, instead of jotting down shorthand to dictate later, they need to type whole sentences so it takes longer.

 

[EdLongshanks]

Even in my 10 years or so. Everytime some wingnut in a cubicle--god knows wher--comes up a new application for our powerful IT systems it boiled down to a handful of mouseclicks for us per patient. Now. These guys need jobs. So the mouseclicks were ever expanding.

Now, now, no need to riff on the poor IT guys, we were just doing what we were told.

Actually, it wasn't us. This is a case where government regulation got us. There was a day when the girls in the front office took a picture of your insurance card and billed it. You got to pay the remaining portion.

Now, however, each different insurance product/plan has different requirements. The government demands that women over 40 be offered a mammogram. This has to be done in the exam room because of HIPPAA. Click. Does the doctor verify that this patient is in need of physical therapy? Click. Has the patient been informed of his right to consult another physician? Click.

It wasn't the IT guys adding clicks - in fact, our goal in life was to reduce the clicks. But the requirements kept getting larger. The biggest insurance companies use a payer program called "Facets". People, like me, who can just CONFIGURE that silly program are worth $75/hr. The company that writes the program is on a constant and futile campaign to make it simpler.

 

[BPlaysItCool]

Duplication

Ed. No. You guys are cool.

The OP's reference. It's not bad right. Kind of like. Health care is robotic suckage, signed Patient. But I'm sayin. Ok patient. On Medicare. Who fears the Death Panels. Tell us how to give you the world on a 15 minute platter. And make it romantic.

I want to see how that works with the game that's on the field.

 

[BPlaysItCool]

I was especially impressed with the author's comment about the importance of the physical exam "ritual." From personal experience for myself and other family members, I really agree with this. Specialists, more so than primary care, barely touch patients anymore. I have often thought at specialist appointments that what happened at the appointment could have been done over the phone. This was esp notable when I was my Mom's caregiver and I had to A) take off work and B) transport a person with limited mobility to the office. I realize you can't bill for that but I really think it would have made me feel like "something was done" for all my effort.

Also, EHRs are great as far as making info accessible, esp between sites. I think it depersonalizes the encounter, though. I have seen a few personal physicians who have been typing the note into the record during the appointment. You might say this is no different from writing with a pen in a chart but it is. To type in the computer they have to turn away from the patient and, instead of jotting down shorthand to dictate later, they need to type whole sentences so it takes longer.

Here's what being behind the scenes to the events you decribe reveal. In pediatrics because that is what I know most recently.

The physician that looks you in the eye more. That does a more thorough physical exam on your baby--maybe. Buit definitely the one who talks to you more about what your concerns are. The one who doesn't make you feel rushed. The one who looks in the home life to make sure baby's environment is a nurturing and well-educated one. That's the same doc who stays 2 - 3 hours late doing all the charting. Making sure das Fuhrer's papers ah in oudah.

The one who blows out the door at 5 pm. Scarf blowing in the convertible's porsche's wind by 5 past 5. That's the one pecks furiously, gets it all done in 15, hears the signs and sx that will kill baby, does the exam, and barely looks you in the eye. Rushes you out the door. If their good they can fake a little customer schmooze but not much. Adminstration loves them. The are the models of efficiency everyone praises. They also make more for the Company.

This is healthcare. Plodding on it's course. We will all feel this intense pressure. The time squeeze of constant acceleration. Technology full throttle. The whole way. Human contact....some ragged, hippy on the side of the road back at the on-ramp.

 

[wholeheartedly]

Wow, did Nas change his screen name?

 

[EdLongshanks]

Wow, did Nas change his screen name?

Yeah, I understand, but this is too rhythmic for Nasrudin. He would consider sticking to a rhythm to be conforming to the man.

 

[Pons Asinorum]

Yeah, I understand, but this is too rhythmic for Nasrudin. He would consider sticking to a rhythm to be conforming to the man.

Hilarious. And yes, the Nas thought popped into my head as well. I don't think it's him.

 

[Lazarus]

The way I see it: we are experienced in the real world. We have been jaded but hopefully not yet by the medical system. Our background is an asset, and I think that we as a whole are more educated as to how to work with others than the typical traditional.

Also, I believe the doctor of the past...is well the doctor of the past. Medicine is becoming tech heavy, and I think many older docs are left in the dust and it takes a toll on their practice. Cost cutting is inevitable, which will result in driving that efficiency up. I would like to think that good computer skills can achieve that vaunted efficiency while at the same time take care of actually viewing the patient as a human being and not just another number to crank through.

I welcome technology in medicine, but I think we are still in that ugly teenage years with pimples and body odor and all the rest. I think a lot of the problems in healthcare have to do with the fact that health care organizations and people involved do not seem terribly dynamic. (I could be wrong) But from my experience change is slow and painful in healthcare, especially if is not directly involved in a clinical process. If it isn't a big machine that spits out images, then it is in the periphery of interest for the majority of healthcare professionals.

I would like to think that the younger generation of docs and nurses will be more flexible with change from growing up in this information age. I would like to especially think that non-trads will be even better at it than others.

In regards to B's sermon on proche docs, that will always be the case. Some people go into Medicine for the wrong reasons, or the right reasons but the reality of medicine is much different than expected. The medical field cranks out a lot of jaded, emotionally dry individuals. Maybe I am projecting my own fears, concerns as well as my hopes and dreams of going into medicine onto this issue.

 

[BPlaysItCool]

The way I see it: we are experienced in the real world. We have been jaded but hopefully not yet by the medical system. Our background is an asset, and I think that we as a whole are more educated as to how to work with others than the typical traditional.

Also, I believe the doctor of the past...is well the doctor of the past. Medicine is becoming tech heavy, and I think many older docs are left in the dust and it takes a toll on their practice. Cost cutting is inevitable, which will result in driving that efficiency up. I would like to think that good computer skills can achieve that vaunted efficiency while at the same time take care of actually viewing the patient as a human being and not just another number to crank through.

I welcome technology in medicine, but I think we are still in that ugly teenage years with pimples and body odor and all the rest. I think a lot of the problems in healthcare have to do with the fact that health care organizations and people involved do not seem terribly dynamic. (I could be wrong) But from my experience change is slow and painful in healthcare, especially if is not directly involved in a clinical process. If it isn't a big machine that spits out images, then it is in the periphery of interest for the majority of healthcare professionals.

I would like to think that the younger generation of docs and nurses will be more flexible with change from growing up in this information age. I would like to especially think that non-trads will be even better at it than others.

In regards to B's sermon on proche docs, that will always be the case. Some people go into Medicine for the wrong reasons, or the right reasons but the reality of medicine is much different than expected. The medical field cranks out a lot of jaded, emotionally dry individuals. Maybe I am projecting my own fears, concerns as well as my hopes and dreams of going into medicine onto this issue.

Solid counterpoint. Didn't mean to preach. I respect your background to much for that. What I meant though. I don't think health care professionals have the wheel. They are trying to cope with increasing demands for data manipulation under tremendous cost pressure. This, to me, is a big let down for people who want more interaction in their appointments.

Good technology skills will definitely help you move quickly so that you can at least gain some more contact points from visits. That part didn't really fit my sermon. Is that a nontrad thing? Seems unlikely.

I would say you are onto something if you want to say we can communicate better. Because before real communication begins, being able to relate to patients is key. And more living gives you more possibility to relate to others. Reasonable enough. And that's probably why they let us in. So we can be in the exam room with other students and they can see better how to open yourself to the troubles of others. Otherwise we would just be a waste of their resources.

I laughed hard the first time I saw some @sshole talking on his cell phone in a public place, when at least you could see the phones recognize they weren't talking to you. I kept laughing until the entire world was doing the same and I was in the stoneage. It's getting to the point where i think most people find phone calls dreadfully too personal. So I think technology is changing everything. And not for the good either.

But mainly I wanted to say that your question was good. Good because there's only the groping for answers. And also that i don't think the real problems you're suggesting are not the result of provider characteristics so much as a changing landscape. One that is enevitable from our society's choices in how we do healthcare.


PS. I don't know what you all are talking about or who Nas is. But you just gave me and idea for my signature.

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