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

Re: How Did Our Medical Notes Become So Useless?

#141

Post by int_19h » Sat, Jan 05, 2019, 2:10 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…

> 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.

I think there's a big difference between third parties interfering with those notes for some profit motive, and the person who those notes are about interfering for privacy reasons, no matter how misguided.

Re: How Did Our Medical Notes Become So Useless?

#142

Post by maxerickson » Sat, Jan 05, 2019, 2:17 AM UTC

mcny wrote: post #131

vonseel wrote: post #120

Earlier quoted context omitted.

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 diff…

It's rooted in an absurd confidence in the interview process actually successfully evaluating candidates.

In practice, I bet places that emphasize that attitude tend to hire people that the interviewers like socially.

Re: How Did Our Medical Notes Become So Useless?

#143

Post by freedomben » Sat, Jan 05, 2019, 2:39 AM UTC

giobox wrote: post #136

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 the…

Totally unsubstantive, but an interesting anecdotal psychological phenomenon occurred while reading your comment. Before I got to this line:

> As a Brit

I read your comment with no accent, but after I read that line my brain switched your "voice" to a British accented one :-)

Re: How Did Our Medical Notes Become So Useless?

#144

Post by tacon » Sat, Jan 05, 2019, 2:40 AM UTC

ams6110 wrote: post #60

dvtrn wrote: post #19

Earlier quoted context omitted.

every time I've done it the response is always defensive, ie "why do you need them" I was asked this once after requesting mine. I flatly said "I don't", and waited. The person on the other end of the line was clearly thrown off by this, probably expecting something they could dish out a canned response to, hoping I'd give up. It was obvious from their voice they were scrambling for what to say to that. A bit of rigm…

Side question, would the "right to be forgotten" also entitle you to call your doctor and demand that all your medical records be destroyed?

My understanding is that, in the US, your medical records are the property of the healthcare provider, absent some contractual language otherwise. The new thing was the federal law that required them to give you a copy of everything at cost. Before that, the only sure way to get a copy of your medical records was to sue the provider and perform document discovery.

Re: How Did Our Medical Notes Become So Useless?

#145

Post by freedomben » Sat, Jan 05, 2019, 2:43 AM UTC

int_19h wrote: post #140

ambicapter wrote: post #86

Earlier quoted context omitted.

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.

Agreed. It's your private data and it's also your body! If you end up getting worse treatment due to not sharing data, it's on you. As an adult and the owner of my body, that's my right to decide for myself.

Re: How Did Our Medical Notes Become So Useless?

#146

Post by cordite » Sat, Jan 05, 2019, 3:18 AM UTC

limeblack wrote: post #4

arielweisberg wrote: post #3

Medical notes are largely fiction IME. You should request all your medical records from any doctor you have seen and start demanding they correct them. You will be shocked at the lies they tell about you. You will be even more shocked down the road when you find out how these lies can hurt you.

Yes at least with paper they were typically tied to one hospital. Now with Epic they are basically automatically pulled over.

The product for this is called Care Everywhere for epic to epic transfers.

An example handout from Yale New Haven Hospital about it: https://projectepic.ynhh.org/Epic%20Newsletters%20and%20Fact...

You can also find out more about cross-vendor interchange at https://carequality.org/

Re: How Did Our Medical Notes Become So Useless?

#147

Post by microcolonel » Sat, Jan 05, 2019, 3:23 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 had a surgery a little over a year ago (in Toronto), and before that surgery they were reviewing the just the details from the stay. It was full of stuff that literally never happened, and incorrectly recorded numbers. I was pretty amazed at quite how incorrect it was.

Re: How Did Our Medical Notes Become So Useless?

#148

Post by yomly » Sat, Jan 05, 2019, 3:34 AM UTC

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…

Are you a doctor? (I would guess not)

I am surrounded by doctor family members and friends (and nearly trained as a doctor) - diagnosis comes from incredibly vague datapoints and so context (and additional data points) are so valuable.

Patients are also often unreliable narrators. Having everything on record (but properly protected) is tantamount to being able to give the best care you can.

Re: How Did Our Medical Notes Become So Useless?

#149

Post by saulrh » Sat, Jan 05, 2019, 3:34 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…

The relative risk of driving while having ADD/ADHD (accidents/km with / accidents/km without) is around 1.54 [1]. This isn't horrible, of course, but it's still bad.

Non-disqualifying visual impairments have a relative risk down around 1.2, implying a surprisingly low cutoff for a visual impairment being disqualifying. "Severe behavioral problems due to ageing (dementia)" have a RR 1.45. A category covering epilepsy, narcolepsy, and other conditions causing sudden interruptions/disturbances in consciousness is at 1.84, and those conditions require medical sign-off in every country I checked. Diagnosed alcoholism amortizes to around 2, and that'll get you a breathalyzer or suspended license right quick.

The cutoff for being ticketed is is observed to lie around a relative risk of 4, which is where cell phones come in. The cutoff for being arrested on the spot, being legally drunk, is a relative risk well above 10 and probably up around 40.

Interestingly, almost nothing is as bad as being a teenage male, which carries a relative risk around 7. Teenage females are around 5.5.

That all said... while we can certainly complain about rampant misdiagnosis - I wish I had a dollar for every time someone told me that I'm just addicted to stimulants - my opinion is that this particular rationale for disqualification is absolutely justified. There's a reason I don't drive.

[1] https://www.toi.no/getfile.php/Publikasjoner/T%C3%98I%20rapp...

Re: How Did Our Medical Notes Become So Useless?

#150

Post by yomly » Sat, Jan 05, 2019, 3:42 AM UTC

freedomben wrote: post #145

int_19h wrote: post #140

Earlier quoted context omitted.

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

Agreed. It's your private data and it's also your body! If you end up getting worse treatment due to not sharing data, it's on you. As an adult and the owner of my body, that's my right to decide for myself.

Quite surprised to see such strong opinions on this issue - I can obviously sympathise with a desire to privacy but personally hold faith in doctor confidentiality.

More pressingly - how can a doctor provide the best care in the absence of records?

Imagine trying to ship a bugfix for a complex system where you don't have the source code and the business owner is refusing to give you the documentation but will sue you and ruin your career if you make a mistake.

I'd probably refuse to see the patient given how much pressure doctors are under to not make a mistake.

What happens if you got a nasty gash and wanted the wound treated and the doctor wanted to issue antibiotics as a precaution but you had a penicillin allergy (which you either forgot to disclose or simply didn't know about but were tested for at some stage in your childhood)