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Why Doctors Reject Tools That Make Their Jobs Easier

blogs.scientificamerican.com

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Re: Why Doctors Reject Tools That Make Their Jobs Easier

#41

Post by LeonB »

bsder wrote: post #3

Part of the issue is that the doctor is on the hook if the tool fouls up. Consequently, having an extremely skeptical viewpoint on tools is perfectly rational. I can also tell you from discussions with doctors that one of the problems is that the intersection of GUI programmer, competent engineer, and medical domain knowledge is either a null set or a single person. (For example: EEG analysis seems to be a natural fi…

> intersection of GUI programmer, competent engineer, and medical domain knowledge is either a null set or a single person

Ah interesting.

My neighbor's son is a doctor who needed better software. He trained himself to become a GUI programmer. The resulting company is very succesful. (As reported by his mother, so I'm allowing for some parental bias.)

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#42

Post by cf498 »

Balgair wrote: post #36
Fomite wrote: post #23

Earlier quoted context omitted.

Yeah - I work a lot in healthcare associated infections, and a good 80% of the stuff I read about "We're from Silicon Valley and we're here to help..." just ends with me going "They're going to kill people."

I've second hand experience with this. Though not a lethal situation (thank the heavens!) the mindset was dead on. A grad student in the BioEng lab was doing her PhD on a fall detection sensor for the elderly. Kinda like what the new Apple watch is supposed to do, but, you know, something that actually works. The lab was working with a device manufacturer that was looking to branch into medical devices as a new marke…

What most people dont realize, depending on the country, those press for emergency buttons for the elderly are not considered an emergency call. Including the advertisement you see on buses targeting people fearing a heart attack. Meaning, it is not guaranteed that the message will go through. It is an app like any else with the same reliability. That was fortunately the point where my former boss declined a contract.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#43

Post by Someone »

cf498 wrote: post #32
Fomite wrote: post #23

Earlier quoted context omitted.

Yeah - I work a lot in healthcare associated infections, and a good 80% of the stuff I read about "We're from Silicon Valley and we're here to help..." just ends with me going "They're going to kill people."

I think this is something that isnt that present in our profession as it should be. If you are an electrical engineer, it is clear and present, that your products might kill someone if you screw up. The same goes for a mechanical engineer. And it will be your responsibility. If you screw up and should have known better, you might even go to jail for negligence. We on the other hand have the Therac-25. We claim to be…

Therac-25 was thirty years ago, and still is the go to example. That made me wonder. If you compare, for example, https://en.wikipedia.org/wiki/List_of_bridge_failures#2000–p... or https://en.wikipedia.org/wiki/List_of_structural_failures_an... with https://en.wikipedia.org/wiki/List_of_software_bugs, software doesn’t look that deadly.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#44

Post by megy »

Balgair wrote: post #36
Fomite wrote: post #23

Earlier quoted context omitted.

Yeah - I work a lot in healthcare associated infections, and a good 80% of the stuff I read about "We're from Silicon Valley and we're here to help..." just ends with me going "They're going to kill people."

I've second hand experience with this. Though not a lethal situation (thank the heavens!) the mindset was dead on. A grad student in the BioEng lab was doing her PhD on a fall detection sensor for the elderly. Kinda like what the new Apple watch is supposed to do, but, you know, something that actually works. The lab was working with a device manufacturer that was looking to branch into medical devices as a new marke…

> Kinda like what the new Apple watch is supposed to do, but, you know, something that actually works.

Does the Apple watch not work?

> But if they had been under clinical trial already, there was a real possibility that real people out there would have been harmed severely (a 'bad' geriatric fall can become lethal).

How would that be different if they didn't have a device? They would have died anyway, right?

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#45

Post by Balgair »

megy wrote: post #44
Balgair wrote: post #36

Earlier quoted context omitted.

I've second hand experience with this. Though not a lethal situation (thank the heavens!) the mindset was dead on. A grad student in the BioEng lab was doing her PhD on a fall detection sensor for the elderly. Kinda like what the new Apple watch is supposed to do, but, you know, something that actually works. The lab was working with a device manufacturer that was looking to branch into medical devices as a new marke…

> Kinda like what the new Apple watch is supposed to do, but, you know, something that actually works. Does the Apple watch not work? > But if they had been under clinical trial already, there was a real possibility that real people out there would have been harmed severely (a 'bad' geriatric fall can become lethal). How would that be different if they didn't have a device? They would have died anyway, right?

> How would that be different if they didn't have a device? They would have died anyway, right?

Maybe. If they think that the device will help them in their hour of need, then they may be taking chances they normally would not have. To have something remote brick and then not tell the people that it was bricked is a gigantic ethical violation.

> Does the Apple watch not work?

Not to a medically relevant level:

"Apple Watch cannot detect all falls. The more physically active you are, the more likely you are to trigger Fall Detection due to high impact activity that can appear to be a fall.”

https://support.apple.com/en-us/HT208944

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#46

Post by Swizec »

throwaway287391 wrote: post #33
Swizec wrote: post #18

Earlier quoted context omitted.

It's like my bird's vet said once: If you start measuring, you're gonna find stuff. The more you dig, the more you find. Does it mean your bird is sick? Eh look at him, does he look like a sick bird? My girlfriend can be very ... concerned. We spent $1000 in vet bills before a real avian expert was like "Guys, he's fine. Look how happy he is. He just loves the attention." Apparently one of his tests for vet interns i…

> Apparently one of his tests for vet interns is to tell them "This bird is sick. Figure it out". Then he gives them a perfectly healthy bird. Their bias always makes them find something. Seems like the "bias" in that case is likely due to an authority figure intentionally misleading them in the context of a "test", where one naturally assumes they're not being deceived by the very premise of said test? If an actual…

I think the lesson he’s teaching is that examination should be hollistic, not just focus on specific tests. Different tests are appropriate in different situations and they often give conflicting results.

I’m no vet but if you have to dig hard for signs of illness, the patient likely isn’t sick. Our bird had increased uric acid. Could be anything. It was a little high.

If he was actua sick we wouldn’t be guessing whether the number is high. It’s be 10x. Waaay out of bounds. A clear signal.

It’s like in product design. Your conversion rate inproved 0.05% after you ran an experiment for 2 days. Is that a signal or noise? Eh probably just noise. Observe longer.

The problem with comfortably saying the client is wrong is tht they’re the authority figure. They have years of data, you have 30 minutes with the patient.

And yes I have had vets casually chat with me for 2 hours when they did spot something suspicious in the bird’s behavior and wanted to observe longer to see if it’s a pattern.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#47

Post by escherplex »

Fomite wrote: post #24

An alternative headline is "Tool Makers Make Tools That Don't Help Doctors". I know a ton of colleagues who flinch every time someone mentions that this'll just hook into the EMR system, because they know everything will be broken and tedious for years before another vendor comes along. At a conference I was at recently, I'm nigh positive "Decision Support Tool" was a dirty word.

Also, for seasoned professionals you have to factor in malpractice and insurance coverage as contributing to the inertia.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#48

Post by ALittleLight »

throwaway287391 wrote: post #33
Swizec wrote: post #18

Earlier quoted context omitted.

It's like my bird's vet said once: If you start measuring, you're gonna find stuff. The more you dig, the more you find. Does it mean your bird is sick? Eh look at him, does he look like a sick bird? My girlfriend can be very ... concerned. We spent $1000 in vet bills before a real avian expert was like "Guys, he's fine. Look how happy he is. He just loves the attention." Apparently one of his tests for vet interns i…

> Apparently one of his tests for vet interns is to tell them "This bird is sick. Figure it out". Then he gives them a perfectly healthy bird. Their bias always makes them find something. Seems like the "bias" in that case is likely due to an authority figure intentionally misleading them in the context of a "test", where one naturally assumes they're not being deceived by the very premise of said test? If an actual…

I'm not a vet, but if I were and someone said "This bird is sick." I hope the first question I'd ask is "Why do you think so?" Not to doubt the person but to figure out what the presenting symptoms were.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#49

Post by skwb »

escherplex wrote: post #47
Fomite wrote: post #24

An alternative headline is "Tool Makers Make Tools That Don't Help Doctors". I know a ton of colleagues who flinch every time someone mentions that this'll just hook into the EMR system, because they know everything will be broken and tedious for years before another vendor comes along. At a conference I was at recently, I'm nigh positive "Decision Support Tool" was a dirty word.

Also, for seasoned professionals you have to factor in malpractice and insurance coverage as contributing to the inertia.

I've found mostly these are given mostly as cover. Those are important considerations, but: A) most CDS is considered educational, and therefore is not supposed to replace an expert's opinion B) insurance coverage is sorta BS because most health systems are moving away from pure fee for service revenue models. Besides, I feel like you should maybe do your job as a doctor to ensure the best care for your patients than hyper optimizing your own reimbursement.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#50

Post by DanBC »

onetimemanytime wrote: post #30
DrJaws wrote: post #21

Earlier quoted context omitted.

Plus radiation. Every CT scan increases your odds of cancer. Also, mammography or even colonoscopies have been proved for most of the population to do more harm than good. cochrane is full of meta-studies about it. The medical industry is very shady.

>> Plus radiation. Every CT scan increases your odds of cancer. If the doctor makes money from your CT Scan you are absolutely right to question the need. Conflict of interest and all. Sure you increase the chances of cancer but that has to be weighed by what can happen if you don't do the CT Scan.

You also need to balance what happens if you do have the scan too.

Over-testing leads to over-diagnosis, and that can be harmful.

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