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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

#71

Post by alsetmusic »

Balgair wrote: post #45
megy wrote: post #44

Earlier quoted context omitted.

> 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…

> Apple Watch cannot detect all falls…

If we pick apart disclaimers, I think we will find that nothing works. /gentle_sarcasm

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#72

Post by cgdcraig »

Someone wrote: post #43
cf498 wrote: post #32

Earlier quoted context omitted.

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.

I'd imagine a lot of places where software is part of a safety critical system also come with physical fail safes. An example being burst plates on pressure vessels, if the software that controls pressurization spasms and causes an over pressure the physical fail safe will prevent a catastrophic accident.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#73

Post by Fomite »

conanbatt wrote: post #68
zdragnar wrote: post #54

Earlier quoted context omitted.

Safety first, full stop, no exceptions. Until correctness can be done easily in accessible programming languages with a decent developer pool, iteration in this space, along with other life-critical spaces such as trains, planes (and wouldn't automobiles be nice too?) is sadly a long, manual process compared to web development. Edit: to expand a bit on correctness, think Coq but with the ease of Java or Typescript. E…

> Safety first, full stop, no exceptions. And here you are, cutting-edg hospitals running 2012 versions of modern software, and paying millions of dollars for the privilege. The direction has to be exactly the opposite, by giving the patient increasingly more control over his own health.

Having seen several talks from some patient advocates recently, I'm skeptical that's a good idea.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#74

Post by Pharmakon »

conanbatt wrote: post #68
zdragnar wrote: post #54

Earlier quoted context omitted.

Safety first, full stop, no exceptions. Until correctness can be done easily in accessible programming languages with a decent developer pool, iteration in this space, along with other life-critical spaces such as trains, planes (and wouldn't automobiles be nice too?) is sadly a long, manual process compared to web development. Edit: to expand a bit on correctness, think Coq but with the ease of Java or Typescript. E…

> Safety first, full stop, no exceptions. And here you are, cutting-edg hospitals running 2012 versions of modern software, and paying millions of dollars for the privilege. The direction has to be exactly the opposite, by giving the patient increasingly more control over his own health.

Patients are the worst at their own health, and often deluded about their ability to manage it. Gwyneth Paltrow and homeopaths don’t rake in money because people make great decisions. When you “empower” patients past their competence you get Steve Jobs in the ground. If he had just been another schmuck, he’d probably still be alive.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#75

Post by Latteland »

Balgair wrote: post #37
cf498 wrote: post #32

Earlier quoted context omitted.

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…

Agreed. The Order of the Engineer is a good place to start and bringing that tradition down into comp-eng/sci would be a nice start. https://en.wikipedia.org/wiki/Order_of_the_Engineer

Interesting, had not heard of that. What should we computer programmers, we flexible always trying new things without enough tried and true practices think of real engineers, what should they think of us?

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#76

Post by brownbat »

projectileboy wrote: post #63
Zelphyr wrote: post #58

Earlier quoted context omitted.

> doctors do not want tools that are clunky And yet every EMR system I've ever seen is comically bad. Why the medical providers haven't revolted over being forced to use those things is beyond me.

Because it’s the same situation as with any enterprise software - the buyers are not the users, and they are evaluated at how well they did or not do their job based on a whole host of criteria that have absolutely nothing to do with satisfied users.

Buyers? I want the makers trained as users.

Everything I've optimized really well was after a week or so using the old bad solution.

Programs made for me, to automate some part of my job? Invariably break some part of my workflow that promptly gets labeled an edge case.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#77

Post by conanbatt »

Fomite wrote: post #73
conanbatt wrote: post #68

Earlier quoted context omitted.

> Safety first, full stop, no exceptions. And here you are, cutting-edg hospitals running 2012 versions of modern software, and paying millions of dollars for the privilege. The direction has to be exactly the opposite, by giving the patient increasingly more control over his own health.

Having seen several talks from some patient advocates recently, I'm skeptical that's a good idea.

I think health services are some of the most misunderstood by the population above everything else.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#78

Post by opo »

tx21 wrote: post #5

Flashy article title clickbait. Doctors are not fools. If a tool truly made their job easier, it would not be rejected out of hand. Job security for physicians is rarely the issue, there are plenty of sick people.

>...Job security for physicians is rarely the issue, there are plenty of sick people.

Yea you would think so... Unfortunately, in medicine, just because a computer program is better then a Dr at diagnosing a patient is no guarantee it will be used. The classic example here was the MYCIN expert system developed in the 1970s. MYCIN was shown to outperform infectious disease experts by 1979 in a blind testing:

>... Eight independent evaluators with special expertise in the management of meningitis compared MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis. MYCIN received an acceptability rating of 65% by the evaluators; the corresponding ratings for acceptability of the regimen prescribed by the five faculty specialists ranged from 42.5% to 62.5%. The system never failed to cover a treatable pathogen while demonstrating efficiency in minimizing the number of antimicrobials prescribed.

https://jamanetwork.com/journals/jama/article-abstract/36660...

https://en.wikipedia.org/wiki/Mycin

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#79

Post by conanbatt »

telchar wrote: post #53
skwb wrote: post #49

Earlier quoted context omitted.

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…

Nevertheless there is concern about any data that goes into an EMR. There is always concern about what happens in the worst case scenario where something very bad happens to a patient and their whole record is examined in a courtroom after the fact. If, say, a machine learning model predicts that thing X will happen to the patient and it wasn't acted on, a hypothetical lawsuit may go worse for the provider than if th…

Some very good points. In the practice of medicine, and in particular in the litigious US, you cant ask questions you wont act on. You are liable for the responses, so might as well not ask.

Stupid af.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#80

Post by conanbatt »

yellowapple wrote: post #55
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.

And of course "just hook into the EMR" is fraught with problems as it is, what with HL7 quirks and proprietary APIs and homegrown interfaces and all that jazz. Even "better" when there's no concept of " the EMR". My foray into healthcare IT was at a hospital/clinic district that used no less than 4 EMR systems (one new and one legacy for the main two hospitals, plus one new and one legacy for all the satellite clinic…

Yes, its a mess. And its because none of them work for the specific use cases very well. For all the things told about it, EPIC is still the best out there.
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