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How Did Our Medical Notes Become So Useless?

blogs.jwatch.org

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Re: How Did Our Medical Notes Become So Useless?

#101

Post by conanbatt »

samsolomon wrote: post #43

I've done a good bit of thinking about medical note taking. To me it's a little odd that hospitals are the ones who keep this information. I'd think that the records should belong to patients—it's about them after all. And that the patients would provide access to doctors or hospitals. Right now I've got a personal medical journal that has things like: * Sickness - Date Range and Notes * Flu Shots - Date * Injuries -…

> To me it's a little odd that hospitals are the ones who keep this information. I'd think that the records should belong to patients—it's about them after all. And that the patients would provide access to doctors or hospitals.

This is absolutely the future, with the ubiquitous devices and cloud-like infrastructure. But we are decades away from with with entire segments of the population not even having an email account.

Re: How Did Our Medical Notes Become So Useless?

#102

Post by standardUser »

limeblack wrote: post #32
jermaustin1 wrote: post #30

Earlier quoted context omitted.

That's amazing. I guess, in the US, we only started tracking patients recently. I had to call and have my old records faxed from my old GP in Texas to one in New Jersey, and then again from that GP to my NEWER one in New York. Earliest record was from when I was 7, since neither my mother or I remember who my pediatrician was before then.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

This is a very important point. Individuals should be able to censor aspects of their own medical records. It's not just mental illness. Getting regularly tested for STDs/AIDS or having evidence that could be interpreted as a pre-existing condition are other aspects of a person's medical history that can cause problems with potential employers or insurers.

Re: How Did Our Medical Notes Become So Useless?

#103

Post by nickda »

Scoundreller wrote: post #48
petermcneeley wrote: post #7

Medicine seems like a technological wasteland. They put "notes" into text boxes and call it "using computers". I wish I had both CS/SE experience and Medical experience so that I could understand what keeps this field in the 1970s. I have suspicions.

It seems like most of these articles focus on the documentation side. There are other elements, like med/consult/lab/diagnostic imaging orders going to the relevant person/department instantly. With a handy interface for following them along, cancelling or re-scheduling them at any time. A nurse doesn’t need to follow a provider around to find out what the new orders are, they show up automatically on their own task…

This is true, but the interaction between the doctor and the nurse was invaluable. The context of those orders and the nurse's knowledge of the patient were used to come up with a plan together. Reducing that interaction to "order giver" and "order taker" greatly reduces the quality of patient care. I was recently in the hospital for a week and this was an issue several times.

Re: How Did Our Medical Notes Become So Useless?

#105

Post by timthorn »

IshKebab wrote: post #92
goldcd wrote: post #5

In (the UK at least) your medical notes follow you as you sign on with a new GP (General Practitioner - first point of medical contact for anything non-urgent). Now knew this theoretically happened, but was quite bemused to see it happen in practice. I rescued a rat from the silken-jaws of my pseudo-homicidal cat, and the ungrateful rodent bit through half of my finger - I thought it would be sensible to have a check…

Yeah in theory they do but in practice if you move around a lot (like pretty much everyone does these days) they get lost. It's just surgeries posting paper notes to other surgeries. Very archaic and unreliable. They did try to digitise everything several years ago but somehow managed to waste £13bn and produced nothing. Completely incompetent. Record keeping is one area of the NHS that is a total embarrassment.

> managed to waste £13bn and produced nothing.

Not true. A massive amount was wasted, but useful services were delivered as part of that £13bn, such as N3, PACS and the Spine.

Re: How Did Our Medical Notes Become So Useless?

#106

Post by bobowzki »

sxg wrote: post #54
limeblack wrote: post #32

Earlier quoted context omitted.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…

As an MD, thank you for this comment.

Re: How Did Our Medical Notes Become So Useless?

#107

Post by mrestko »

standardUser wrote: post #102
limeblack wrote: post #32

Earlier quoted context omitted.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

This is a very important point. Individuals should be able to censor aspects of their own medical records. It's not just mental illness. Getting regularly tested for STDs/AIDS or having evidence that could be interpreted as a pre-existing condition are other aspects of a person's medical history that can cause problems with potential employers or insurers.

This goes back to the central thesis of the article: that interference from non-physicians (i.e. insurers, billers) are destroying the usefulness of notes.

Physicians are bound by both a professional duty and oath as well as legal liability to keep your medical information in the strictest of confidence. But it is nearly impossible to know in advance when a particular piece of medical information will become important for the treatment of a patient. Hiding it because of concerns about insurance or employment is not a solution--it's an indication that insurance and employment have undue influence on or access to a professional record.

Re: How Did Our Medical Notes Become So Useless?

#108

Post by derefr »

egocentric wrote: post #99
lkrubner wrote: post #36

Earlier quoted context omitted.

" how these lies can hurt you " True story, I had a major illness in my late 20s. And apparently I have a high tolerance for pain, so the nurses and doctors repeatedly underestimated how much pain I was in. I can be in incredible pain and still hold it together and answer questions in a calm and rational manner. This made one doctor suspicious that I was faking the whole thing. So then I tried to adjust my behavior.…

"I have a high tolerance for pain" I know you said "apparently", but how can you know this for a fact? How can anyone's pain tolerance be objectively measured? I've always wondered about this...

Pain causes not just symptoms, but also physical signs. Increased blood pressure, for one. These are the physiological consequences of the way pain signalling happens in the body. People can even die from these physiological effects.

The physiological signs of pain occur mostly as a consequence of the way we consciously experience and process pain. (This is why "general anesthetic" works: central processing of pain is required before sensory input is actually registered as painful, and so, without the brain there to decide that a thing is painful, the physiological consequences don't happen. Pain that would give you a heart attack if you were awake doesn't cause the slightest physiological problem when you're unconscious from general anesthesia.)

If you are receiving a lot of "painful-stimulus describing" sensory input, and you're consciously experiencing those stimuli as painful qualia—but your body shows relatively little physiological response—then you have a high tolerance for pain.

This can be measured by using a standardized painful stimulus (e.g. a sub-cutaneous injection of a standardized dose of some insect's venom) together with an fMRI (or just self-reporting) to measure the intensity of the painful qualia, and various physiological monitors (EKG, etc.) to measure physiological response to the pain.

I believe this has been done before specifically in the case of certain sects of monks who like to demonstrate the depth of their meditative ability by tolerating large amounts of pain. They did the experiment to try to figure out whether the monks are tolerating an experienced pain, or merely are somehow not experiencing the painful stimulus as pain-qualia.

Re: How Did Our Medical Notes Become So Useless?

#109

Post by Gibbon1 »

sxg wrote: post #54
limeblack wrote: post #32

Earlier quoted context omitted.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…

A huge problem for people with a mental health dx in their history is doctors reflexivity dismiss complaints as a 'mental issue'.

Re: How Did Our Medical Notes Become So Useless?

#110

Post by Gibbon1 »

bobowzki wrote: post #106
sxg wrote: post #54

Earlier quoted context omitted.

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…

As an MD, thank you for this comment.

Beware, people with mental illness also suffer from ordinary ailments.
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