When Patients Read What Their Doctors Write • Hacker News Board

Re: When Patients Read What Their Doctors Write

#81

Post by jghn » Mon, Aug 18, 2014, 1:55 PM UTC

SoftwareMaven wrote: post #4

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

I 100% agree with [1]. I used to work with a group of MDs and the paternalism was shocking. While not universal, many of them relished the role of oracle on high and were uneasy with any change which would take them off of the top of that pillar.

On the actual topic at hand, my last doctors office had a system where I could see everything they wrote on a web portal and it was eye opening. The number of times I'd say X and they'd write Y was astounding. It was primarily the nurse and not the actual MD but I learned that I needed to be very careful about everything I said as the image of me that someone would have if they only read those notes was nearly the opposite of what I was trying to convey.

Re: When Patients Read What Their Doctors Write

#82

Post by novalis78 » Mon, Aug 18, 2014, 1:59 PM UTC

judk wrote: post #61

novalis78 wrote: post #28

the only problem - in the US - with this is that the more you tell them the more they will bill you. It's like as if every little piece of information that otherwise should help a doctor identify what's wrong and result in a faster and more accurate diagnosis makes the billing department's job that much easier. Now they don't have to break down one single item and charge you 10 ways, they can break down each of your…

Extraordinary claims require extraordinary evidence. Please share.

From personal experience, I saw how a level 1 sprained wrist ER visit turned into a level 4 case, using some of my detailed description to establish criteria that made the case seem bigger than it actually was.

It's called "upcoding", "phantom billing" etc and are common medical billing fraud practices. http://www.business2community.com/health-wellness/the-5-most...

Re: When Patients Read What Their Doctors Write

#83

Post by eli » Mon, Aug 18, 2014, 3:09 PM UTC

jacquesm wrote: post #72

kamaal wrote: post #65

Earlier quoted context omitted.

>>I met a number of doctors who took the attitude that if they couldn’t figure out what was wrong, it must be in my head. I hear you. I went through a very similar phase a few years back here in India. It turns out it was just a simple infection being dragged around by my doctor just to keep the consultation fees coming. It took a little internet research and a change of doctor to get the problem resolved. In another…

Is there a review site for doctors? It would seem to me that such blatant profiteering at the expense (both health and moneywise) of patients ought to be exposed.

Yes, ZocDoc. Also Yelp to some degree.

The reviews, in my experience, are less useful than you might imagine. People have very different ideas of what makes a good doctor and they seem much more likely to write reviews when they're not happy.

Re: When Patients Read What Their Doctors Write

#84

Post by eli » Mon, Aug 18, 2014, 3:11 PM UTC

gingerlime wrote: post #64

I've met the guys behind a German startup called "Was hab ich?"[0] - which translates roughly to "what have I got?". It's a platform that lets people post their doctor's notes and have med students interpret it for them in an easy to digest form. It helps both patients better understand their conditions and med students learn how to read and interpret diagnosis. It's a non-profit as far as I'm aware, since part of th…

Very interesting. What happens if the med students give advice contrary to the physician?

Re: When Patients Read What Their Doctors Write

#85

Post by GhotiFish » Mon, Aug 18, 2014, 3:19 PM UTC

You know. I checked the source (still checking) but it really seams what they did was give patients access to their notes, and then ASK them if that improved things.

How could this honestly be considered evidence that this is a good idea? This is the standard of evidence that a Homeopath would present.

Who could take this seriously? Patients reported taking their medication more regularly, here's an obvious question: Did they actually take their medication more regularly?

Maybe somewhere in the body this is answered. Let me keep looking.

edit: NO

  although self-reports fall short of objective data, open 
  notes may prove to be a simple intervention that has an 
  important effect on medication adherence.

Good, glad they lamp-shaded it.

edit2: http://www.myopennotes.org/

oooooohhh. This makes more sense. This is a paid for study.

Why does this have 200 upvotes?

Re: When Patients Read What Their Doctors Write

#86

Post by CWuestefeld » Mon, Aug 18, 2014, 3:29 PM UTC

I've had Crohn's disease for about 35 years, and my experience makes me agree strongly with the article.

I have to go see my GI doctor a couple of times a year[1]. He's the department head at a teaching hospital, and so my appointments with start with a first-year resident examining me. After that, the "real" doc comes in, and the resident presents to the doc his findings and conclusions.

While I guess that some folks might object to an examination by "only" a resident, I find that this helps me because of the interchange between the resident and the teaching doc. At the same time the doctor is teaching his resident, he's also leaking that teaching to me. As a result, I come to understand my condition better than I would if were just going to a regular GI practice. And because management of a chronic disease like Crohn's is all about understanding its effects specific to your own case, getting this kind of feedback is invaluable.

[1] I moved recently, and need to find a new doctor with whom I can relate to like this. But it's easier to talk about in the present tense.

Re: When Patients Read What Their Doctors Write

#87

Post by hawleyal » Mon, Aug 18, 2014, 3:35 PM UTC

carbocation wrote: post #20

SoftwareMaven wrote: post #4

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

> In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it). People have many values, one of which is health. Deciding not to worry about cholesterol may fit with your value system, but is unlikely to benefit your health. As a doctor, it would be reasonable to try to convince you of the benefit of carin…

Cholesterol specifically is in the realm of relative unknowns for medicine. Especially the way it is measured, it may or may not be a predictor of heart disease or other maladies. It is also unknown why some populations have a higher baseline cholesterol, and how that affects their longterm health.

Speaking as a person who has had very high cholesterol from childhood with very healthy eating habits and despite being a very active athlete with <5% bodyfat.

Re: When Patients Read What Their Doctors Write

#88

Post by madaxe_again » Mon, Aug 18, 2014, 3:44 PM UTC

SoftwareMaven wrote: post #4

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

Doctors absolutely hate knowledgable patients, from what I can tell, however.

I've just spent two years begging for an ultrasound because I've strongly suspected I have gall stones - and my GP has consistently rebutted me, and has written stuff like "hypochondriac" in my notes - he left the room, didn't lock his computer. Tut tut.

I initially tried playing totally stupid and letting them reach their own conclusions, but they just kept going "norovirus". When I then started talking about Murphy's sign, cholecystitis, why this lead me to think gall stones - they responded with a complete shut-down, get out of my surgery, type affair.

Went abroad. Got an ultrasound. Severe gallstones. Took them back to my GP here, they refused to even look at them. About to go abroad again to have a cholecystectomy.

So. Educated patients - if this is to help healthcare, doctors have to be on board too, and I don't think they ever will be, as an informed patient is viewed as a threat, as you say.

Re: When Patients Read What Their Doctors Write

#89

Post by Someone1234 » Mon, Aug 18, 2014, 3:58 PM UTC

madaxe_again wrote: post #88

SoftwareMaven wrote: post #4

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

Doctors absolutely hate knowledgable patients, from what I can tell, however. I've just spent two years begging for an ultrasound because I've strongly suspected I have gall stones - and my GP has consistently rebutted me, and has written stuff like "hypochondriac" in my notes - he left the room, didn't lock his computer. Tut tut. I initially tried playing totally stupid and letting them reach their own conclusions,…

Maybe you should file a complaint with the medical standards board, sounds like you'd have a valid case if this story is true.

Although I'm assuming you're in a country where you'd have a medical standards board or some kind of complaints procedure, which not all have...

Re: When Patients Read What Their Doctors Write

#90

Post by madaxe_again » Mon, Aug 18, 2014, 4:11 PM UTC

Someone1234 wrote: post #89

madaxe_again wrote: post #88

Earlier quoted context omitted.

Doctors absolutely hate knowledgable patients, from what I can tell, however. I've just spent two years begging for an ultrasound because I've strongly suspected I have gall stones - and my GP has consistently rebutted me, and has written stuff like "hypochondriac" in my notes - he left the room, didn't lock his computer. Tut tut. I initially tried playing totally stupid and letting them reach their own conclusions,…

Maybe you should file a complaint with the medical standards board, sounds like you'd have a valid case if this story is true. Although I'm assuming you're in a country where you'd have a medical standards board or some kind of complaints procedure, which not all have...

I'm in the UK - it's straightforward to complain, but nothing comes of it, apart from even shittier treatment the next time around, because they know you've complained about them!