How Did Our Medical Notes Become So Useless? • Hacker News Board

Re: How Did Our Medical Notes Become So Useless?

#131

Post by mcny » Sat, Jan 05, 2019, 1:18 AM UTC

vonseel wrote: post #120

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…

You were downvoted for this, and I agree that it’s a controversial stance, but there is a genuine point to be made here. It’s not uncommon for teenagers to be misdiagnosed with mental illness or ADHD and either of those are disqualifiers for FAA medical certification, military pilot careers, and likely many other military, law enforcement, and intelligence careers. IIRC, a prolonged history of ADHD treatment is enoug…

> It’s not uncommon for teenagers to be misdiagnosed with mental illness or ADHD and either of those are disqualifiers for FAA medical certification, military pilot careers, and likely many other military, law enforcement, and intelligence careers. IIRC, a prolonged history of ADHD treatment is enough to disqualify military entrance for any MOS without waiver. Waivering prior ADHD diagnosis requires a costly and difficult process to undiagnose the patient and prove that he or she no longer has the condition and was incorrectly diagnosed in the first place, at least if you are trying to get FAA certified for a Class 1.

How do you feel about the (I presume underlying notion, at least when it comes to programming jobs) that a "bad" hire is costly and we'd rather let ten potentially great candidates go rather than accidentally hire one very bad candidate?

Re: How Did Our Medical Notes Become So Useless?

#132

Post by nradov » Sat, Jan 05, 2019, 1:24 AM UTC

hopler wrote: post #126

nradov wrote: post #34

Earlier quoted context omitted.

Some doctors have been concerned that patients lack the education needed to interpret their own charts. So when patients don't understand something they call back and ask a lot of questions, which doctors see as a waste of time. (I don't agree with this perspective, just giving some context.)

In the US that's fine, because the doctor can bill for the follow-up consultation.

Answering questions over the phone is usually not billable.

Re: How Did Our Medical Notes Become So Useless?

#133

Post by thomasfedb » Sat, Jan 05, 2019, 1:26 AM UTC

mrestko wrote: post #107

standardUser wrote: post #102

Earlier quoted context omitted.

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 importan…

I think this comment really hits it on the head.

Your medical record is meant to be a confidential record read only by those who are sworn to care for and protect you, and by nobody else for no other purpose.

As a student doctor it's alarming to think that people do not feel they can trust their doctor with their medical history. I wonder if this is particularly a problem with the US healthcare system.

Re: How Did Our Medical Notes Become So Useless?

#134

Post by thomasfedb » Sat, Jan 05, 2019, 1:29 AM UTC

lostlogin wrote: post #129

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…

Funny-Looking-Kid (FLK) and other such diagnostic gems are present in notes of that vintage.

FLK isn't a diagnosis, but it is a useful clinical impression that might lead to one, even now.

Re: How Did Our Medical Notes Become So Useless?

#135

Post by thomasfedb » Sat, Jan 05, 2019, 1:34 AM UTC

derefr wrote: post #108

egocentric wrote: post #99

Earlier quoted context omitted.

"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 i…

Contrary to the myth, general anaesthesia does not in fact fully defeat physiological responses to painful stimulus.

I've watched first hand as the anesthetist has said "whatch the monitor as the surgeon does this bit" and seen the response.

Re: How Did Our Medical Notes Become So Useless?

#136

Post by giobox » Sat, Jan 05, 2019, 1:42 AM UTC

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…

I'm not entirely convinced the UK/NHS should ever be used as a good example for handling medical notes, at least by today's standards.

As a Brit who left the UK a while ago, I recently had cause to request my "medical records" from my former GP. Of course such data can presumably be requested via the UK's Data Protection Act, but the lack of any kind of standard process or checks really shocked me, given the care they are treated with in places such as the US via specific legislation such as HIPPA and so forth.

My GP posted my entire history after one phone call to their receptionist via Skype, did no checks what so ever on my identity beyond confirming my name and DoB to look me up, I was left close to speechless following the call. I can't profess to be an expert on the topic of rights to medical data in the UK, but the above was true of my own experience and others I know, I've heard similar stories from a handful of GP friends and family. There is literally nothing stopping someone pulling your name and DoB from a Facebook account or similar and doing the same in many cases.

The number of GPs without electronic record keeping of any kind in the UK frankly amazes me as well, supposedly the NHS will be paperless by 2020...

Re: How Did Our Medical Notes Become So Useless?

#137

Post by cabaalis » Sat, Jan 05, 2019, 1:54 AM UTC

I deal with various EHRs every day of my life, and 4-digits-worth of providers. The primary barrier is that practice managers are working to get data standardized, but get pushback from the providers who are busy doing their jobs being doctors and not data scientists.

Some EHRs can streamline via templates and workflow. Others don't. I've literally had practice admins not implement new practices that would document properly and facilitate easy reporting because they would not be able to sell the change to the providers.

I'm not blaming providers for the data issues. They have a job to do and they do it. It just doesn't always get documented in a reportable manner. There needs to be an easier way to document, or some kind of Middleware that documents for them.

I see people a whole lot smarter than me trying to use ai to interpret notes. I personally think they are just facilitating the ongoing poor documentation problem. And things will slip through the natural language cracks, and it could be a potential health hazard.

Re: How Did Our Medical Notes Become So Useless?

#138

Post by derefr » Sat, Jan 05, 2019, 2:05 AM UTC

thomasfedb wrote: post #135

derefr wrote: post #108

Earlier quoted context omitted.

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 i…

Contrary to the myth, general anaesthesia does not in fact fully defeat physiological responses to painful stimulus. I've watched first hand as the anesthetist has said "whatch the monitor as the surgeon does this bit" and seen the response.

Not at the levels we like to use for surgery, certainly. But my understanding is that a “medically-induced coma” (the potentially-irreversible palliative-care kind) does suppress all pain signalling. Likewise, people in a vegetative state have no physiological response to pain. If you completely suppress central functioning, then you completely suppress pain response.

(There might still be a local release of pro-inflammatory cell-danger-response purines from the wound site that do things when they hit various organs/tissues on their way through the circulation, but I believe we don’t tend to call those “pain signals”, for the same reason we don’t call them that in plants or fungi.)

Re: How Did Our Medical Notes Become So Useless?

#139

Post by xfitm3 » Sat, Jan 05, 2019, 2:06 AM UTC

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…

I'm ok with my doctor knowing my complete history, but I do not want my insurance company or any third party to have access to these records.

Re: How Did Our Medical Notes Become So Useless?

#140

Post by int_19h » Sat, Jan 05, 2019, 2:07 AM UTC

ambicapter wrote: post #86

drb91 wrote: post #81

Earlier quoted context omitted.

Your profession should not dictate your rights to your data.

No one is stopping you from accessing your data. The question is to whether you should be able to stop your doctor (or your emergency doctor) from accessing your medical data. Sounds like a bad idea.

It might well be, but shouldn't it be up to you to decide that? It's your private data.