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

121–130 of 131 posts

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#121

Post by paulie_a »

TeMPOraL wrote: post #85
brownbat wrote: post #76

Earlier quoted context omitted.

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.

Same problem. Makers are not paid to think like users. Makers are paid to satisfy whoever's actually paying .

If makers dont have a fundamental understanding of how the users will utilize it, the makers are making a bad product. Every developer should do customer service and a sales call on a regular basis.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#122

Post by 08-15 »

ItsMe000001 wrote: post #93
08-15 wrote: post #52

Earlier quoted context omitted.

> 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 eve…

The problem with that study is that "people who take a CT scan" is not exactly an unbiased sample of the general population.

Now compare this to

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2477708/

> only a single one in your life

"A single dose" as in "a discrete event". Another single dose the next month is (probably) harmless again. Cells react to radiation with repair mechanisms, and once that activity subsides, the event is over.

Radiation exposure isn't linearly cumulative. The argument that it is was made before we even knew the structure of DNA! Today, we know better.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#123

Post by yellowapple »

conanbatt wrote: post #80
yellowapple wrote: post #55

Earlier quoted context omitted.

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.

Indeed it is, though that ain't really saying much. EPIC was one of the ones in the "new" category for us (for the satellite clinics specifically; the actual hospitals instead went with CPSI - aka "COBOL, Perl, and Server Issues"). It was definitely the least bad of all the EMRs and EMR-like systems we used.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#124

Post by TeMPOraL »

paulie_a wrote: post #121
TeMPOraL wrote: post #85

Earlier quoted context omitted.

Same problem. Makers are not paid to think like users. Makers are paid to satisfy whoever's actually paying .

If makers dont have a fundamental understanding of how the users will utilize it, the makers are making a bad product. Every developer should do customer service and a sales call on a regular basis.

> If makers dont have a fundamental understanding of how the users will utilize it, the makers are making a bad product.

Well, exactly. That's half of the reason why enterprise, medical, restaurant and other similar software generally sucks.

> Every developer should do customer service and a sales call on a regular basis.

In B2C, sure. In B2B for the examples I mentioned above, a "sales call" is where the problem starts. On such a call, you'll get the opinions of people paying for software, not of those using it.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#125

Post by ItsMe000001 »

08-15 wrote: post #122
ItsMe000001 wrote: post #93

Earlier quoted context omitted.

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 eve…

The problem with that study is that "people who take a CT scan" is not exactly an unbiased sample of the general population. Now compare this to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2477708/ > only a single one in your life "A single dose" as in "a discrete event". Another single dose the next month is (probably) harmless again. Cells react to radiation with repair mechanisms, and once that activity subsides,…

I also recommend at least the "Conclusion" section of this document, selected as an example, not as the one definite document: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3611719/ It is a good read overall too. You make it sound as if it does not matter. Apparently that is not the general medical opinion.

I also don't see what the problem with the selection of people is supposed to be. Those selected are more likely to not be able to repair DNA damage? I think this particular selection makes no difference for the purpose.

Overall, OP said "there is no evidence" and it seems that yes, there is. What you think of that evidence is not the question, OP had said there isn't any. When I look at the actual recommendations it seems that most medical people don't think so, after all, the recommendation still is to limit the radiation exposure, not just for the frequently exposed (radiation workers) but also for those one-time patients.

Even on a per-event basis reducing the amounts of radiation was and is a major design goal for the devices. Does not look like those who are involved in all of this think there is no problem.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#126

Post by HeadsUpHigh »

ItsMe000001 wrote: post #119
HeadsUpHigh wrote: post #115

Earlier quoted context omitted.

This study is solely focused on childhood and adolescence CT scans. Any radiation dosage you take during childhood has magnified effects.

Thanks for pointing that out, but, okay, children and adolescents count too? OP responded to a specific comment, I responded to OPs comment. I don't understand your point in that given context. I'd think showing one study - I didn't bother to look any further - that shows a risk was sufficient. Since even adults have plenty of still dividing cells left I see it as reasonable to assume that adults are at risk too, eve…

I don't remember the exact number but when it comes to cancer risk increase getting a regular 100 mSv x-ray as a kid counts something like 10 xrays of an adult done one after another( i.e. single dose). That's because any mutations that happen will stay with you for the rest of your life plus propagate to a lot more cells in total as your body is still growing. So while an important topic for some specialties it would be wrong to make broad statements based on this.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#127

Post by ItsMe000001 »

HeadsUpHigh wrote: post #126
ItsMe000001 wrote: post #119

Earlier quoted context omitted.

Thanks for pointing that out, but, okay, children and adolescents count too? OP responded to a specific comment, I responded to OPs comment. I don't understand your point in that given context. I'd think showing one study - I didn't bother to look any further - that shows a risk was sufficient. Since even adults have plenty of still dividing cells left I see it as reasonable to assume that adults are at risk too, eve…

I don't remember the exact number but when it comes to cancer risk increase getting a regular 100 mSv x-ray as a kid counts something like 10 xrays of an adult done one after another( i.e. single dose). That's because any mutations that happen will stay with you for the rest of your life plus propagate to a lot more cells in total as your body is still growing. So while an important topic for some specialties it woul…

There is no "broad statement": There only is a specific response to a specific comment. I responded to "there is no evidence" - I don't have to show existence of 100% knowledge in the response, only that "no (zero) evidence" is not true. That is not a "broad statement", especially since I myself did not make one, only pointed to studies for the subject. Those studies don't conclude with "no evidence found".

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#128

Post by paulie_a »

TeMPOraL wrote: post #124
paulie_a wrote: post #121

Earlier quoted context omitted.

If makers dont have a fundamental understanding of how the users will utilize it, the makers are making a bad product. Every developer should do customer service and a sales call on a regular basis.

> If makers dont have a fundamental understanding of how the users will utilize it, the makers are making a bad product. Well, exactly. That's half of the reason why enterprise, medical, restaurant and other similar software generally sucks. > Every developer should do customer service and a sales call on a regular basis. In B2C, sure. In B2B for the examples I mentioned above, a "sales call" is where the problem sta…

In either case the developer the should get a first hand experience about the pain points. Developers tend to be isolated and build things that really doesn't fit the need that is required. Ask the potential customer and they will come. (Maybe, but at least the developer has a better idea of things to build)

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#129

Post by opo »

HeadsUpHigh wrote: post #116
opo wrote: post #78

Earlier quoted context omitted.

>...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: >... Eigh…

There are good reasons why MYCIN and similar systems were never accepted, mainly the fact that diagnosing an infectious disease is pretty useless on it's own. If the doctor has already narrowed it down to an infectious disease, telling which one it is is trivial. The hard part is getting there.

>... diagnosing an infectious disease is pretty useless on it's own.

I don't think that was what was being measured.

The evaluation was a comparison of:

>...MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis.

In that evaluation:

>...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 fact that the acceptability ratings of the five faculty specialists ranged from 42.5% to 62.5% implies that this isn't a trivial problem.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#130

Post by 08-15 »

ItsMe000001 wrote: post #125
08-15 wrote: post #122

Earlier quoted context omitted.

The problem with that study is that "people who take a CT scan" is not exactly an unbiased sample of the general population. Now compare this to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2477708/ > only a single one in your life "A single dose" as in "a discrete event". Another single dose the next month is (probably) harmless again. Cells react to radiation with repair mechanisms, and once that activity subsides,…

I also recommend at least the "Conclusion" section of this document, selected as an example, not as the one definite document: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3611719/ It is a good read overall too. You make it sound as if it does not matter. Apparently that is not the general medical opinion. I also don't see what the problem with the selection of people is supposed to be. Those selected are more likely…

> Overall, OP said "there is no evidence" and it seems that yes, there is.

This is evidence for a correlation between the number of CT scans and cancer incidence. To jump to the conclusion that the cancer is caused by the radiation from the CT requires a leap of faith.

The funny thing is, if an epidemiological study shows that low dose ionizing radiation is beneficial (radioactive apartment buildings, nuclear navy workers), it's dismissed by a completely ad-hoc "healthy worker effect" or "healthy student effect". But in a study of people who received a CT scan, where you should expect a "sick people effect" (healthy people don't get CT scans), you "don't see a problem".

Post reply on HN