U.S. workers have gotten less productive – no one is sure why

absolutely - your consciousness is your most precious resource!

the hardest part is the tension with the external guilt - but that is the point of the guilt after all

> I've read that doctors now spend as much as 50% of their time documenting their work. Companies such as Epic, which provide the software that hospitals use to build databases of patient data, have been big winners in the new world of hospitals-depending-on-software. But did the doctors become more productive? By almost any measure, they became less productive.

I'd ask another question: did lawsuits decrease? I'd imagine that a lot of this software is to avoid lawsuits. America is especially litigious and that's got to correlate strongly with the increase bureaucracy.

I also suspect that a factor at play is that people are losing trust in the whole system. Most people now know that productivity has skyrocketed while salaries have remained relatively flat. With increasing economic disparity (not even just the West) it is no wonder that people become less productive. Who tries hard at a game that they believe is rigged against them? (doesn't matter if it is or isn't, just the belief)

> People in tech keep thinking more tech will solve problems

Because historically it has. But there are different types of tech. Tech enabled the modern world. It is the new medicines we have to cure illnesses that devastated populations. It is the chemicals that enable us to grow enough food to sustain our populations. It is everything from a wheel to the computers we use to make more efficient wheels that use less resources. But it is also naive to think that tech alone can solve every problem. It is also naive to think that tech can't create new problems. To create tech that solves problems we need to think long and hard about the intricate complexities involved and gather the expertise from relevant domains (an often missed, but essential, component). The other problem is that people hand wave away things like climate change saying "tech will solve it" rather than investing in said technology and waiting for it to magically appear. I do think tech is an important tool in solving many of the problems we face, but you're right that they are not all technology dependent (which is a continuous scale of weights, not a binary option).

Also, we're a tech forum. Peoples' expertise here is in tech. So they see things through that lens and it is also very likely that the most we/they can contribute to solving these problems is, in fact, through technological means. The trick is to remember that tech isn't a cure-all and that the problems we face are exceedingly complex. Over simplifying is often harmful.

I talk a lot about this flexibility gap in my day job in UX. Getting an organization onto a digital platform is great but a lot of them don’t recognize all the small ways that their current system’s flexibility is helping them.

With big systems though I honestly think GUIs can only go so far, even at their very best, and any system that is required to be complex at some level will require expert knowledge of the system itself. That’s extra work and an extra burden for someone with the critical experience that an organization relies on.

For doctors and the like it would make sense to try a system where the critical person/expert has an assistant who is a systems expert and does a lot of the needed data entry and the like. Doctor doesn’t have to worry about the system, they can talk to the assistant who manages all the extra work. If the system needs to change for any reason the assistant manages that and the doctor doesn’t have to worry about it.

I think of this assistant role as the human API layer. It’s not far off from some social programs like insurance navigators, who help individuals find health insurance, including working through options and even—critically—filling out forms for folks.

ETA: It’s a thing! I didn’t know: https://en.wikipedia.org/wiki/Medical_scribe

Based on working in the industry, and hearing from healthcare practitioners not quite first-hand, but second-hand.

You mention profit efficiency, but all three of my points make sense even in light of that: (i) insurance is literally the way doctors get paid; (ii) lawsuits are hella expensive, and (iii) regardless of profit incentives you can't not follow the law.

The software that doctors use is terrible. It's a perfect combination of extreme complexity, domination by just a couple companies (Epic and Cerner), legacy software (some still written in mumps, I hear!), and tons and tons of regulation.

https://en.wikipedia.org/wiki/MUMPS

I've never seen the same doctor twice in a row.

What I've noticed is that EMR has greatly reduced the amounts of screw-ups or delays caused by not having the right information at hand, or having to repeat tests. Also, since there's now a terminal in every examining room, I can see what amount of effort is required to use the EMR tool (Epic in the case of my provider), and it doesn't seem all that onerous. I can guesstimate the additional amount of time that they spend outside of clinic hours, completing their records for the day, and again, it doesn't seem onerous.

For a few years I had to fill out a lengthy medical history form, every time I visited a clinic, but that's pretty much gone today. My primary care doctor just retired, and her replacement took up the baton without skipping a beat. She can also easily delegate to her physician's assistant or nurse practitioner, so they can all work as a team, with instant access to the same information.

Now I have noticed something interesting. The urgent and primary care clinics all have a terminal in every examining room, and the clinicians perform their examinations while seated at the terminal, except when they actually have to poke around. That's where it seems quite efficient.

In the hospital wards, they still don't have a terminal in each room, meaning that each clinician has to look things up at centralized terminals, remember them (or not), and has no access to information. If they need some information, they will come back with it, next time their make their rounds, which might be the next day. And they screw up. My dad had an episode that took him through an ER, to a regular hospital bed for a few days, then to a rehab ward. I had all of his records at my fingertips thanks to MyChart on my laptop. The doctors and nurses were lost, they completely overlooked the documented diagnosis that was at the root of is condition, and didn't believe me about it.

Some of the nurses in the hospitals now have a terminal on a wheeled cart, that they bring on their rounds.

What I'm guessing is that in the days of handwritten records, the doctors were mostly winging it.