The Dark Side of Doctoring

Its almost exactly analogous to being an airline pilot, everything easy enough to automate was automated multiple human generations ago, now the primary purpose of the human is judgment calls, emergencies, monitoring, what boils down to non-computer systems administration using hopefully sterile biochemical machinery rather than CPUs and disks, equipment failures ...

None of what you say negates the need to make improvements. Doctor workload impacts the quality of care, therefore we should investigate solutions and mitigate the problem where possible.

The times are a' changin'

Dr. Emory Brown's work out if U Mass in anesthesia is a data point for this. He claims to have a working general anesthesia machine. From the talks and data of his I have seen, it really does work. Yes, it's not good for a pediatric car accident victims, but for tonsillectomies or proctology exams, you know 'routine' general anesthesia, the thing works great. He says that he uses it in his own surgery suite with better 'results' than a human can obtain.

Yeah, it's 10 years out, maybe 20. But this trend of replacing doctors with robots (and getting better outcomes) is not going away. So, that there is a current bottleneck may be true, but in the near future, we just won't need doctors for a lot of areas of medicine.

Related: http://www.wbur.org/commonhealth/2017/05/12/boston-electroni...

I always see people ragging on EMRs. They're inefficient, have poor UX, require way too much documentation, etc. These are all fair criticisms, but I don't think people spend enough time asking why. Why are all the major EMR systems shitty in exactly the same way?

I think there's 2 main parts to the answer. The first is the sales process. The people selling EMRs to hospitals aren't selling their product to clinicians, they're selling their brand to the hospital administration. It's like the saying "nobody ever got fired for choosing Oracle", but far worse. The end result is years-long implementation processes, broken promises, and terrible tools that are optimized to allow the hospital to fire a few members of the low-level administrative staff (billing, coding, etc) instead of providing better care to the community they serve.

The second part of this problem is overregulation. The justification is that EMRs should be able to meet a certain level of functionality. Based on personal experience working with these regulations, I'm convinced that the real reason these certifications exist is to prevent new players from entering the market. They are very much in the spirit of "well all these legacy systems do [something], so _obviously_ everybody else should too" without ever leaving room to come up with a better solution. They shackle you to terrible design choices and assume that all hospitals, from a 10-bed critical access hospital to a 500-bed academic medical center, should all be run the same way. And worst of all, they make it impossible to design a system based on what the HOSPITAL needs, because half of the system is devoted to what the GOVERNMENT needs. Kind of like how people complain about interoperability between electronic medical systems. So the government introduces legislation to mandate interoperability, by requiring implementation of poorly-defined "standards" (designed by committees comprised mostly of, you guessed it, representatives from legacy vendors). From personal experience, I can say that every. single. one. of the interfaces required for federal certification is completely unable to be reused by actual hospitals. But that's the entire purpose, that's exactly why lobbyists paid so much money to get the regulations passed in the first place! If potential new competition has to sink thousands of man-hours every year into building useless functionality, that's thousands of man-hours that didn't go into making their product competitive and disrupting the marketshare of legacy systems. Meanwhile, legacy systems are maintaining their market share, not by improving their product and helping healthcare providers do a better job. Instead they're actively creating situations where smaller hospitals are forced to choose between buying onto the licenses of larger hospitals or shutting their doors.

Obviously this is all just my personal opinion.

This isn't much the case anymore from my experience. A generation ago I recall it being general knowledge that if a loved one had to go into the nursing home you would bankrupt and have medicaid pay. A relative tried that this recently and is close to destitute as a result.