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| Why Doctors Quit | |
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| Tweet Topic Started: May 31 2015, 10:51 AM (216 Views) | |
| George K | May 31 2015, 10:51 AM Post #1 |
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Finally
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Charles Krauthammer:
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A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
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| Mikhailoh | May 31 2015, 11:03 AM Post #2 |
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If you want trouble, find yourself a redhead
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I can vouch for everything he said there. |
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Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball | |
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| jon-nyc | May 31 2015, 11:15 AM Post #3 |
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Cheers
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Especially the feasting nicely part. |
| In my defense, I was left unsupervised. | |
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| Jolly | May 31 2015, 12:03 PM Post #4 |
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Geaux Tigers!
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Scribes. An ancient job description birthed by the Obama EHR command. Savvy hospitals no longer have a doc write his own orders...no, they hire a college kid with some medical-related class background to shadow the physician and the scribe enters in the EHR what the doctor says. It works. Kinda. In an area prone to mistakes, interject another human link, a less well-trained human link and see what happens. Oh, the delicious, simple idiocy of it all... |
| The main obstacle to a stable and just world order is the United States.- George Soros | |
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| Mikhailoh | May 31 2015, 12:07 PM Post #5 |
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If you want trouble, find yourself a redhead
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They dangled the carrot in front of the administrators who could not resist. Smart for them, bad for us. There will be at least one more round of immense federal funds to fix what they have broken, and it cannot be done by going back to the old systems. |
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Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball | |
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| jon-nyc | May 31 2015, 12:51 PM Post #6 |
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Cheers
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Are you speaking as patient, taxpayer, or healthcare IT contractor? |
| In my defense, I was left unsupervised. | |
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| George K | May 31 2015, 02:50 PM Post #7 |
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Finally
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Let me speak, as a physician. Ask any doc who knows his way around an OR which are the most dangerous points of an operation. Every one will tell you takeoff and landing. That's when the patient's system reacts to the meds given for induction. Takeoff: that's when the blood pressure falls. That's when you have to establish an airway. Landing: That's when the drugs are wearing off, when you really don't know how emergence will occur. That's when you don't know if the airway will be able to be maintained by the patient him/her self, or you're going to have to intervene with manual methods or pharmacologic means to keep it open. That's when the very real possibility of laryngospasm (RIP Joan) raises it's sphincter-tightening head. That said, our place decided that, rather than having the gas passer sit and chart vitals, drugs, etc manually on a sheet of paper, they would spend hundreds of thousands of dollars to interface all of our anesthesia machines and monitors with a totally non-intrusive 24" computer screen mounted on the machine. The good thing is that I don't have to make the little marks for blood pressure, pulse. I can type in a notation making it legible for everyone. It tracks the amount of gases flowing, but I *still* have to manually enter each drug, the dose, and the site of injection (a pita, because EVERY time, I have to say "right arm"). I also still have to enter values for cardiac rhythm, ventilation, etc. The nice thing is that I can, when the patient comes into the room execute a "macro" which will have the software start pulling data from the machine/monitors. I can enter all the data that I have to after the case is started, and sit and watch things happen. I don't have to worry about forgetting a BP or a pulse. But, once the case is started, it takes about 10 min to do all that. If your case is 20 min long, you don't have much time to enter all that stuff, because, guess what, you still have to take care of the patient. The other frustrating thing is that the machine doesn't understand why the BP is low because the surgeon is leaning on the BP cuff on the patient's arm, causing a false reading. I have to correct those number, because I, as a human, understand that the data are erroneous. That takes time as well. That's not the bad part; that's landing. Once the case is finished, I have several tasks I must accomplish before we leave the room: I have to document all the fluids I gave, I have to click off how emergence is proceeding, and a host of other things. These are all things that, at the most dangerous part of the case, divert my attention away from the patient to my left, to the computer screen to my right. I'm not watching - and that, as an anesthesiologist, is what I do: watch. At a point in the case where something can go south in a matter of seconds, I really don't want my attention drawn away from the patient. Once I take that airway out, there's no excuse for me losing it again - or at least no excuse for getting it back. Looking at a computer screen for 15 seconds can cause me to miss the onset of a laryngospasm, someone who's about to vomit and aspirate. Something bad's going to happen - I just hope it isn't going to be on my watch. |
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A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
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| Klaus | May 31 2015, 02:59 PM Post #8 |
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HOLY CARP!!!
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FIFY. I assume the surgeon may see this a bit differently, no? |
| Trifonov Fleisher Klaus Sokolov Zimmerman | |
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| George K | May 31 2015, 03:02 PM Post #9 |
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Finally
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Nope. Any surgeon will agree. Things almost never go wrong (and I mean life-threatening) after the knife hits the skin. Unless there's uncontrolled bleeding, an embolus, there's very little that happens that's bad. Of course, the surgery might not go as well as one would like, but it's almost never immediately dangerous. |
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A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
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| big al | Jun 1 2015, 09:45 AM Post #10 |
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Bull-Carp
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As a layman, my big beef with EMR is how it doesn't seem to actually do anything. During recent hospital and doctor encounters I've had some involvement with, it seems that each new encounter results in the same questions being asked and, if the answer is not known (name of a drug for which a reaction occurred), the information is guessed at or not recorded. If a bank, a business, or an industry was run like that it wouldn't last too long. There was a time many years ago when making many products was more art than science. As the underlying priciples and processes became better understood, manufacturing became more controlled and results were increasingly better. You couldn't run a steel mill, a chemical plant, or a sutomobile factory with the operator's eye and hand-written production logs today and expect to have the quality, productivity, and precision that are acheived with modern methods. I frankly don't see why medicine shoud be any different and in many ways it isn't or needn't be. The continuous or periodic observations made on patients in a ICU resemble process monitoring. I suspect that at least some functions could be better performed by automatic systems guided by artificial intelligence than are presently managed with persons who may be inattentive, distracted, or less than fully knowledgable in the loop. We're at the point in medicine where the question really needs to be asked and answered - how much of this is craft and intuition not amenable to description and quantization and how much could really be better done by a suitable machine not subject to human failings? Big Al |
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Location: Western PA "jesu, der simcha fun der man's farlangen." -bachophile | |
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| George K | Jun 1 2015, 10:18 AM Post #11 |
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Finally
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No doubt. But this is all being mandated and sold as being comprehensive. All you're seeing is mindless repetition. I know several hundred docs - on a first name basis - and none, not one, has had anything good to say about this process. But, it's forced upon us, lest we pay penalties. Al, what you're seeing, to some extent, is the "cut and paste" note. A doc will be consulted to see a patient. He copies the initial evaluation and paste it in his note, followed by lab work that has already been documented, followed by cardiology and radiology reports, that are available elsewhere in the "chart." When you start looking at these notes, your eyes start to glaze over, and you start to skim, simply because you've read it elsewhere - word for word. You're right about monitoring, but nurses' notes are the same - a series of checkboxes that they tick off at appropriate times, and their comments are pre-digested drivel that you don't read - because there's too much bread and not enough meat. And your question of craft and intuition is spot on - however, we are not yet at the time where a machine can put its "hands" on your belly and feel an abscess, or an appendix, or, perhaps most importantly, nothing significant. When I was taught physical exam, for example, I was taught to always look at a patient's face when I examine an abdomen. You can observe a lot just by watchin'. I'll be interested in hearing bach's comments. He's more of a guy who lays hands on than I am. |
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A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
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| jon-nyc | Jun 1 2015, 02:14 PM Post #12 |
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Cheers
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Well, I'll say one good thing about it. I can log in and get all my records. Beats the hell out of faxing some signed request to the basement of some hospital and hoping for the best. |
| In my defense, I was left unsupervised. | |
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| George K | Jun 1 2015, 02:18 PM Post #13 |
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Finally
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Yes. That is a good thing. If you have all your records in one place. Otherwise, the problem is interoperability. None of them, as Mik will attest, will talk to each other. So, the onus is on you to receive the records as a PDF, and then forward to the other place. Still probably faster than Maggie in the basement, but a PITA nevertheless. |
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A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
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| Mikhailoh | Jun 1 2015, 04:33 PM Post #14 |
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If you want trouble, find yourself a redhead
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What do you do to drive hospital administrators nuts? You pass a bill that can send them to jail for improperly sharing medical records then you tell them all to share the very same medical records with other institutions. I was right in the middle of that ten years ago. Fear and loathing in healthcare. Hilarity and clusterfarks galore. |
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Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball | |
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