After a 12-hour stay in the ICU a couple of years ago, this doesn't surprise me in the least. I was given a different patient's discharge papers by mistake, and when I got all the records of stay for reference afterwards some of the clinician's reports were utterly illegible. I guess this is why I ended up answering the same medical background questions over and over again during the night.
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This looks like a great tool How are you going to deal with the inevitable hurdles of HIPPA compliance? (HIPPA = patient privacy laws in the US, for people who don't know).
As a medical technician in a neuro department, I had to take an illegible referral to the neurologist who wrote it (luckily he was in-house). Even he couldn't read his own handwriting: "But I know the patient, and he needs...".
Why is this tolerated? It seems like such an absurdly basic problem to fix. Years and hundreds of thousands of dollars of advanced medical training is distilled into a note/prescription that looks like a fucking five year old wrote it. It's pathetic.
A personal anecdote: I went to a doctor recently. He opened my notes, squinted at them, and then asked me what medications he had prescribed me. That was my last visit to him.
It's actually an extremely difficult problem to fix. Anything new that restricts doctors in any way, shape, or form has to come from up high, and it also has to be across the board. Few hospitals have the luxury to turn away doctors, and few areas have enough doctors doing general practice. Make a new regulation, and some doctors will sigh and do it - but other doctors will move on... unless there's nowhere to move to that doesn't also have the new requirement.
So maybe instead of adding a layer of technology and all of the costs, privacy concerns, reliability concerns, etc., all that's really needed is basic handwriting training, practice, and expectations of legibility for doctors.
I think we do need technology for all the other reasons described in the log post - like the limitations of paper forms, running out of space to add important information, transcription errors and so on. Sure, the digital version could generate problems of its own but many of those are predictable and preventable as they're well known from other systems.
Retraining people to have better handwriting in adulthood is difficult, and arguably it's not a problem of competence as much as conditions - trying to write on a clipboard balanced on your knee or in a rush before seeing the next patient.
It's complicated by the fact that reporting/recordkeeping requirements are not always medically based, but derived from best practices decided by administrators/ regulators/ legislators which are usually put in place with the best of intentions but without full regard for transaction costs. In the medical context, economic friction is often a function of time rather than money; doctors are trying to deliver a certain standard of care to every patient each shift, and administrative work eats away at that time, resulting in an opportunity cost. Filling out a form for each patient doesn't seem like such a bi thing, but the costs of any inefficiency in the form design etc. add up.
Comments
After a 12-hour stay in the ICU a couple of years ago, this doesn't surprise me in the least. I was given a different patient's discharge papers by mistake, and when I got all the records of stay for reference afterwards some of the clinician's reports were utterly illegible. I guess this is why I ended up answering the same medical background questions over and over again during the night.
-
This looks like a great tool How are you going to deal with the inevitable hurdles of HIPPA compliance? (HIPPA = patient privacy laws in the US, for people who don't know).
As a medical technician in a neuro department, I had to take an illegible referral to the neurologist who wrote it (luckily he was in-house). Even he couldn't read his own handwriting: "But I know the patient, and he needs...".
Why is this tolerated? It seems like such an absurdly basic problem to fix. Years and hundreds of thousands of dollars of advanced medical training is distilled into a note/prescription that looks like a fucking five year old wrote it. It's pathetic.
A personal anecdote: I went to a doctor recently. He opened my notes, squinted at them, and then asked me what medications he had prescribed me. That was my last visit to him.
It's actually an extremely difficult problem to fix. Anything new that restricts doctors in any way, shape, or form has to come from up high, and it also has to be across the board. Few hospitals have the luxury to turn away doctors, and few areas have enough doctors doing general practice. Make a new regulation, and some doctors will sigh and do it - but other doctors will move on... unless there's nowhere to move to that doesn't also have the new requirement.
So maybe instead of adding a layer of technology and all of the costs, privacy concerns, reliability concerns, etc., all that's really needed is basic handwriting training, practice, and expectations of legibility for doctors.
Something, something razor.
I think we do need technology for all the other reasons described in the log post - like the limitations of paper forms, running out of space to add important information, transcription errors and so on. Sure, the digital version could generate problems of its own but many of those are predictable and preventable as they're well known from other systems.
Retraining people to have better handwriting in adulthood is difficult, and arguably it's not a problem of competence as much as conditions - trying to write on a clipboard balanced on your knee or in a rush before seeing the next patient.
It's complicated by the fact that reporting/recordkeeping requirements are not always medically based, but derived from best practices decided by administrators/ regulators/ legislators which are usually put in place with the best of intentions but without full regard for transaction costs. In the medical context, economic friction is often a function of time rather than money; doctors are trying to deliver a certain standard of care to every patient each shift, and administrative work eats away at that time, resulting in an opportunity cost. Filling out a form for each patient doesn't seem like such a bi thing, but the costs of any inefficiency in the form design etc. add up.
Minor nitpick: it's HIPAA, not HIPPA.
Thx. I make that typo frequently.