Medical system errors -reboot

Multiple system errors exist –

Overemphasis on low yield costly tests v astute history taking with focused and thorough examination

We are producing less clinicians and more test reliant drones

If you cannot come to a reasonable diagnosis without ANY tests in most situations, are you really a doctor?

When training we had to justify every test we did

We had had to ask “how will this test change my management?”

The inability to reel in the spiraling costs and inefficiencies from the insurance, pharmaceutical, IT, and investigation industries we deal with

I was at a lecture about a new high sensitivity troponin test

  1. the fact that it required a separate one hour lecture was a statement in itself about how user friendly it was/is
  2. the old test cost 6 cents the new one $3,
  3. 50x more expensive, is silly

When computer discharge summaries first came out it took my resident 45min to 1 hour to do one

lets think about this,

45min-1hr on a now healthy patient,for a letter the gp will spend about 10secs reading, instead of treating sick inpatients

and why does the gp only spend 10s reading it, because the crucial parts are diagnosis treatment and required ongoing Mx

Last witnessed computer discharge took 20-25 mins, better but in the old days 2-5 mins hand written letter

you want that letter online? fine take 10s to scan it

occasionally  you can’t read the illegible handwriting? fine talk to the actual patient his doctor or relatives

The electronic documentation system also comes with its own baggage

the huge cost of equipment, maintenance,electricity,

breakdowns,

log-in delays and inefficiencies,

poorly designed interfaces by people with no medical know-how

but we often choose to ignore these issues why? because technology

Technological advancements need to be   user friendly,cost and time efficient, and  make a significant positive difference to patient care

Also we must not get distracted by documentation at the expense of actual treating patients

What exactly is documentation treating?

It may assist with future presentation, but so will a thorough history and exam at the time of the next presentation,

it’s cool to know the patient is allergic to bees but how does that effect his current broken arm?

he’s had a previous appendicectomy ? cool he probably  will be ok if he needs an anaesthetic, its all about relevance

It may influence circumstances of involving future legal proceedings but you know what? so can getting the job done right now focusing treating  on the patient instead of his paperwork

Bypass the lawyers by getting the treatment right, leaving them nothing

Trying to make things fool proof may not work, eg chest pain protocols/forms

The dr doesn’t have to remember the ins and outs of treating IHD, why? because its on a form now and paradoxically disempowering him, also he is now skewed into treating all chest pains via an IHD check list, reguardless of if they have a PE, aortic dissection or pericarditis etc

We need our drs to focus,be analytical and discerning,triage,be time and cost efficient, empowered and self reliant

but blanket investigation,protocols, unnessesary overdocumentation and undiscerning blind acceptance of new investigations,therapies and systems will achieve none of this

Improve the doctor, the technology is secondary

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