Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

How Did Our Medical Notes Become So Useless?

blogs.jwatch.org

Post reply on HN
Print view View original

41–50 of 206 posts

Re: How Did Our Medical Notes Become So Useless?

#41

Post by zdragnar »

jolmg wrote: post #33
aschneid wrote: post #25

Earlier quoted context omitted.

At Kaiser, you just have to walk into any member services office and request. It doesn't happen right then, but I believe in a few days you get a thumb drive with all of your records on them. However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you.

> However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you. Like what?

There was an interesting discussion earlier on here about the potential emotional harms of suggesting to a patient that they are likely to develop Alzheimer's within a few years (an AI based early detection system).

On the one hand, you might catch it and treat it earlier. On the other hand, it will color every interaction you have with others and cause stress every time you try to remember something. The potential harm may very well exceed the harm of not telling the patient (up to and including suicide).

If a doctor suspects something but lacks evidence, they may simply make a note to look for more signs at subsequent follow-ups. A patient seeing that may read more into it than is there, and subsequently suffer undue stress or paranoia.

Re: How Did Our Medical Notes Become So Useless?

#42

Post by nradov »

DanielBMarkham wrote: post #6

My Primary Care Physician is unable to speak coherent sentences. I'm half-joking, of course. The guy is top-rated, elected head of the state association. He's widely-regarded as a combination of both brilliant with diagnostics and good with people. He just can't complete a sentence when we meet. Why? Because he's got some pad he carries around that takes up all of his attention span. He comes into the room, sits down…

Some provider organizations hire medical scribes to sit in the exam room and do real time EHR data entry so that the doctor can focus on the patient.

Re: How Did Our Medical Notes Become So Useless?

#43

Post by samsolomon »

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 - Date and Notes

* Observations - Date and Notes

* Blood tests - Date and Photos of Tests

Before my yearly checkup (or if I have to visit a clinic) I review the last entries and open them on my phone incase my doctor wants to see any of them.

It works well enough for me, but seems like there could be a ton of opportunity for improvement. I'd love to have a system where my doctor could be notified and comment on new notes or events. Also the ability to bring in my scale, run tracker and other fitness data.

Re: How Did Our Medical Notes Become So Useless?

#44

Post by howard941 »

jghn wrote: post #18
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.

A while back I had a doctor where you could access everything via the online portal. I don't think some of the employees there realized that as there was some truly shocking stuff in there. One thing I learned was that anything I said which could possibly be misconstrued in a negative light was noted in my record as if the negative connotation was accurate.

I think you're being too kind. The person taking notes was (or should have been) trained to listen for and accurately record admissions against interest. If it ever wound up in court stuff like this is presumed to be highly reliable because reasonable people are disinclined to admit to negative things.

This sort of thing highlights the need for broad and bulletproof physician-patient privilege.

Re: How Did Our Medical Notes Become So Useless?

#46

Post by jdeibele »

jolmg wrote: post #33
aschneid wrote: post #25

Earlier quoted context omitted.

At Kaiser, you just have to walk into any member services office and request. It doesn't happen right then, but I believe in a few days you get a thumb drive with all of your records on them. However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you.

> However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you. Like what?

Patient claims to be suicidal.

Re: How Did Our Medical Notes Become So Useless?

#47

Post by mikekchar »

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 -…

One thing I like about Japan, where I live now, is that every time I get a test done (and unfortunately I've had a lot of them recently), they send a copy of the results to me. I have everything my doctor has. He also writes personal notes for himself, but usually they are descriptions of symptoms when I complain about stuff. I could write them down too (and maybe I should), but those are his personal notes just to remind him what was going one when I visited him. I don't need access to that, as far as I'm concerned (although he shows me what he's writing and sometimes I even ask him to show me what he's written on a previous page).

Re: How Did Our Medical Notes Become So Useless?

#48

Post by Scoundreller »

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 scheduler.

Providers can enter orders remotely.

Or allergies just getting verified instead of collected from scratch each visit.

Or billing/appointments happening electronically instead of manually completing forms.

Re: How Did Our Medical Notes Become So Useless?

#49

Post by theseatoms »

nradov wrote: post #31
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.

Support the OpenNotes movement. Patients have a legal right to view their records (with some limited exceptions). But it needs to be easy and happen by default rather than as a special request. https://www.opennotes.org/

Forget "view". I want to own my records. It's my personal data that I've enlisted a professional to gather on my behalf.

Re: How Did Our Medical Notes Become So Useless?

#50

Post by jermaustin1 »

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…

I could be wrong, that's why I said I guess. It was just based on my personal experience in switching doctors a couple times when I moved away from my home town.
Post reply on HN