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

Re: How Did Our Medical Notes Become So Useless?

#171

Post by dublin » Sat, Jan 05, 2019, 6:28 AM UTC

ars wrote: post #56

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…

The US is trying to do this as well. The very famous HIPAA is actually about that, and not as much about the privacy provisions that made it famous. Implementation of this goal though ..... not as successful. Mostly because those who make the electronic record systems don't understand the field well. See: https://news.ycombinator.com/item?id=18781264

Go read the requirements - HIPAA is really 90+% about disclosure and reporting of events that compromised private patient information. There is virtually nothing in HIPAA that is aimed at preventing privacy breaches in the first place. Once a breach is disclosed, the penalties in HIPAA pretty much vanish.

Re: How Did Our Medical Notes Become So Useless?

#172

Post by int_19h » Sat, Jan 05, 2019, 6:33 AM UTC

yomly wrote: post #150

freedomben wrote: post #145

Earlier quoted context omitted.

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…

Whether you should or shouldn't share that information with your doctor is a different question, and is the one where trust etc is relevant. The point here is that the choice to share or not share should be the patient's, regardless. If doctors want to turn down patients that wouldn't share something, that's up to them, of course.

Re: How Did Our Medical Notes Become So Useless?

#173

Post by dublin » Sat, Jan 05, 2019, 6:38 AM UTC

derefr wrote: post #138

thomasfedb wrote: post #135

Earlier quoted context omitted.

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-infl…

Some anesthesiologists believe that, but there's really no solid evidence for it. The reality is that no one really knows how or why anesthetics work, we just know what generally does work. I was told this by an honest doc, who also told me this scary fact: Because it's best to minimize the drugs that put you under (especially gaseous), and b/c we're getting better at walking that line, it's increasingly common to have patients wake up and freak out at the sight of their chest spread open. That's why the anesthesiologist keeps a couple of loaded syringes on the cart ready for emergency use: one is an instant paralyzing agent, the other a powerful memory blocker.

Re: How Did Our Medical Notes Become So Useless?

#174

Post by freshhawk » Sat, Jan 05, 2019, 7:33 AM UTC

yomly wrote: post #150

freedomben wrote: post #145

Earlier quoted context omitted.

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…

Cool. I don't believe you and luckily I am in a position to prove it.

As an expert I require your medical records, so send them to me now.

Everyone else: I will reply to my own comment with a followup if it turns out I am wrong and yomly does actually feel this way.

Re: How Did Our Medical Notes Become So Useless?

#175

Post by novia » Sat, Jan 05, 2019, 8:18 AM UTC

magnetic wrote: post #63

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.

I found omissions to be particularly interesting too. For example, I once declined to take a shot after the doctor explicitly told me that it would most likely not yield any benefit, given the response I had from other treatments. The medical record simply shows that I declined the shot, but not that this was upon strong recommendation from the doctor. This became an issue later when the provider went back to the rec…

Half the goal of note taking is not writing down anything that will implicate you in a future legal battle.

Re: How Did Our Medical Notes Become So Useless?

#176

Post by noddy1 » Sat, Jan 05, 2019, 8:28 AM UTC

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.

I'm a Dr who has just quit my specialist job for the 2nd time to pursue a startup.

You'd think I'd do something medical - I've been in the field 10 years, I should have been able to find a problem IT can address?

To be honest the thought of doing a health IT startup just fills me with dread.

Re: How Did Our Medical Notes Become So Useless?

#177

Post by NoblePublius » Sat, Jan 05, 2019, 8:57 AM UTC

I read number 1 —- “money” — as “doctors lie about what they are doing to get paid more by your insurance company”. Is that unfair?

Re: How Did Our Medical Notes Become So Useless?

#178

Post by bobowzki » Sat, Jan 05, 2019, 9:26 AM UTC

Gibbon1 wrote: post #110

bobowzki wrote: post #106

Earlier quoted context omitted.

As an MD, thank you for this comment.

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

Obviously. I'm not a psychiatrist :-)

Re: How Did Our Medical Notes Become So Useless?

#179

Post by xte » Sat, Jan 05, 2019, 9:42 AM UTC

Problem of medical notes have a name: bureaucracy. The hope is leaving it apart, and today it seems a bit utopia...

Also in terms of "numeric/digital" vs "paper" the point is ignorance: how many people outside IT world (and even inside) do actually know enough a desktop to take their own personal notes in an ordered, usable and useful thing?

IMVHO a so small percentage that we can probably know them all by name. Just take a look at a "common" mailbox: most of them are an utter pile of data, few with some incoherent taxonomies, few even with the sole inbox as an archival place. Than take a look a common "home directories": the very same mess. And if this is for personal and generic data do you think that those people are able to properly not only manage but share helpful information with digital systems?!

Re: How Did Our Medical Notes Become So Useless?

#180

Post by dang » Sat, Jan 05, 2019, 9:51 AM UTC

freshhawk wrote: post #174

yomly wrote: post #150

Earlier quoted context omitted.

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…

Cool. I don't believe you and luckily I am in a position to prove it. As an expert I require your medical records, so send them to me now. Everyone else: I will reply to my own comment with a followup if it turns out I am wrong and yomly does actually feel this way.

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