Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Why Doctors Reject Tools That Make Their Jobs Easier

blogs.scientificamerican.com

Post reply on HN
Print view View original

91–100 of 131 posts

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#91

Post by Johnny555 »

wccrawford wrote: post #39
mamon wrote: post #31

Earlier quoted context omitted.

>> Now if I take the medicine and it's not better in a day or two, maybe then I will want that CT scan. That's what most doctors in my country would do. Are you saying that US doctors will send you to CT right away, just to be sure?

I went to the ER complaining of stomach pains. They heard my description and immediately put me into a room. A few hours later, I had a CT scan confirming that I had appendicitis. I had surgery that same that and was out of the hospital 2 days later. Had they sent me home, medicine or no, things could have gone a lot worse. I'm glad they do the CT scan here and not just send people away until they get worse.

That's exactly what should happen -- you came in with symptoms that seemed more serious than just a stomachache, so you were scheduled for a CT.

It's not like you came in with gas pains and the doctor had to send you for a CT just in case it turned out to be something more serious.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#92

Post by [deleted] »

08-15 wrote: post #52
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.

> Every CT scan increases your odds of cancer. There is no evidence for that statement. More specifically, there is no evidence that a single radiation dose below 100mSv is harmful at all, but plenty of evidence (Taiwanese radioactive apartment buildings, nuclear navy worker study) that it isn't. Muller made it up for political reasons.

[deleted]

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#93

Post by ItsMe000001 »

08-15 wrote: post #52
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.

> Every CT scan increases your odds of cancer. There is no evidence for that statement. More specifically, there is no evidence that a single radiation dose below 100mSv is harmful at all, but plenty of evidence (Taiwanese radioactive apartment buildings, nuclear navy worker study) that it isn't. Muller made it up for political reasons.

There is evidence:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660619/

> Title: Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians

> Conclusions: The increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. Because the cancer excess was still continuing at the end of follow-up, the eventual lifetime risk from CT scans cannot yet be determined. Radiation doses from contemporary CT scans are likely to be lower than those in 1985-2005, but some increase in cancer risk is still likely from current scans. Future CT scans should be limited to situations where there is a definite clinical indication, with every scan optimised to provide a diagnostic CT image at the lowest possible radiation dose.

And about "a single radiation dose": As soon as you get a CT the chances that you will have only a single one in your life are greatly reduced, because you just had that one. So it still is better if the count remains at zero, or your precondition can easily be invalidated.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#94

Post by conanbatt »

Pharmakon wrote: post #74
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.

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.

Health services are in service of the patients, not on your commoner opinion of what health should be and how it should be imparted.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#95

Post by arkh »

Zelphyr wrote: post #58
EB66 wrote: post #57

Earlier quoted context omitted.

I agree. This article is off the mark. On the contrary, doctors want tools that will assist them in providing better patient care outcomes. In all my career, I've never met an anesthesiologist, trauma surgeon nor a hospitalist who has ever expressed a concern that technology will make them obsolete. On the contrary, almost universally these individuals are overworked and are thrilled to hear about anything that might…

> 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 2 main things.

First: you're dealing with humans so you have to let a lot of things possible. Which is how you easily get shitty UI.

Second: everything is a legal horror. Certification, certification, certification.

PS: and third. Most medical software is not chosen by its users but by management.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#96

Post by ivanmaeder »

megy wrote: post #40

> From the thermometer’s invention onward, physicians have feared—incorrectly—that new technology would make their jobs obsolete Is that true, or are doctors incredibly risk averse since they have seen what can happen when something goes wrong, and that is death.

I've also read that physicians can be overconfident in their own abilities:

https://www.ncbi.nlm.nih.gov/pubmed/18440350

> … argue that physicians in general underappreciate the likelihood that their diagnoses are wrong and that this tendency to overconfidence…

More on the combination of algorithms and humans:

https://en.wikipedia.org/wiki/Paul_E._Meehl#Clinical_versus_...

> Meta-analyses comparing clinical and mechanical prediction efficiency have supported Meehl's (1954) conclusion that mechanical data combination and prediction outperforms clinical combination and prediction.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#97

Post by gruturo »

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.

Software doesn't have many opportunities to be deadly, and when said opportunities do exist, this is frequently in regulated fields where safeties are mandated by law (interlocks on a laser or a welding robot arm etc).

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#98

Post by sizzle »

EB66 wrote: post #60
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.

They really are comically bad (Cerner, Epic, Meditech, all of them), but they are effective data silos which is a step up from having that data silo'ed in filing cabinets. People outside healthcare really don't understand the sheer amount of time your physician spends trawling through the medical record in the regular course of doing his or her job. You can think of the patient chart as a shared "My Documents" folder…

My doctor's office just switched to the latest MyChart system and the app on Android has a pretty modern UX, decent usability and shows all my upcoming appointments, lab results, bill statements, etc. No complaints on my end, having access to my records right after my physician enters it into their computer is nice compared to requesting packets of physical paper then having to securely store them from prying eyes...

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#99

Post by vinayms »

> Too many doctors have resigned that they have nothing to add in a world of advanced technology. They thoughtlessly order tests and thoughtlessly obey the results.

Thoughtlessly obeying is undoubtedly a sign of incompetence; a doctor must always use judgement based on patient's condition and not rely on a bunch of numbers, a doctor told me in my teens. However, ordering tech based tests is not thoughtless all the time, at least not with competent doctors. I mean, in this age of self diagnosing based on googling, a doctor not ordering such tests would be seen as incompetent, and even ignorant. Would a doctor risk his reputation, and possibly livelihood, just to prove a point, even when his spidey senses tells him there is nothing severe about the patient's condition when the patient insists on it, directly or indirectly? Only a House would do so. The writer is too eager to generalize for some reason.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#100

Post by kwhitefoot »

jayd16 wrote: post #69
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.

Its really strange how much punishment doctors seem to receive and how much they're willing to take. The hours alone would be laughable in any other industry.

The hours are, to some extent, imposed by the various medical governing bodies either directly or by artificially restricting the supply of doctors. These bodies are composed largely of doctors so the problem is to some extent self imposed. In the UK doctors are not governed by the working time directive because the UK negotiated an opt out so hospital doctors work ridiculous hours. As far as I can tell this problem does not exist to the same degree elsewhere in Europe.
Post reply on HN