[HN Gopher] Why doctors hate their computers (2018)
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Why doctors hate their computers (2018)
Author : mitchbob
Score : 111 points
Date : 2025-08-04 00:41 UTC (22 hours ago)
(HTM) web link (www.newyorker.com)
(TXT) w3m dump (www.newyorker.com)
| mitchbob wrote:
| https://archive.ph/PlnQl
|
| For me, the most interesting part is about 4/5 of the way in and
| starts with
|
| > Some people are pushing back. Neil R. Malhotra is a boyish,
| energetic, forty-three-year-old neurosurgeon who has made his
| mark at the University of Pennsylvania as something of a
| tinkerer. He has a knack for tackling difficult medical problems.
| In the past year alone, he has published papers on rebuilding
| spinal disks using tissue engineering, on a better way to teach
| residents how to repair cerebral aneurysms, and on which spinal-
| surgery techniques have the lowest level of blood loss. When his
| hospital's new electronic-medical-record system arrived, he
| immediately decided to see if he could hack the system.
|
| A great example of participatory design.
| tinix wrote:
| Deja vu...
|
| https://news.ycombinator.com/item?id=44778004
| gnabgib wrote:
| Popular in:
|
| 2023 (100 points, 116 comments)
| https://news.ycombinator.com/item?id=36903220
|
| 2020 (279 points, 319 comments)
| https://news.ycombinator.com/item?id=24336039
|
| 2018 (157 points, 109 comments)
| https://news.ycombinator.com/item?id=18381969
| johntfella wrote:
| The doctor I've been with since 1998 has refused to adopt the
| digital system. He's getting older unfortunately and I suspect in
| another few years he'll be retiring only to be replaced by a
| doctor who embraces digitalization. It's far and few these days
| to find paper only offices. Which is a shame, as I feel the more
| modern the medical system is the less personable, less "family
| doctor" oriented, heck more often only to be bought up by a
| network. Quaint is under rated, futurism is over rated.
| MathMonkeyMan wrote:
| My dad practiced dentistry since the 70s and never digitized
| his office. Every patient had a folder. There was a phone, a
| typewriter, and a calendar. I don't know how insurance claims
| worked, maybe by post.
|
| When I moved to New York I was surprised to find a dentist
| whose practice was much the same, though he did have a few
| computers around. He retired recently.
|
| Computers no doubt can improve things; a lot of it seems like a
| no-brainer. But I'm starting to doubt that they're there to
| improve things.
| johntfella wrote:
| to quote Wendell Berry, "the more superficial and
| unsatisfying our lives become, the faster we need to
| progress"
| vjvjvjvjghv wrote:
| My dentist uses a software that seems pretty efficient. All
| the x-rays and other notes are right there. One big plus is
| that the screen is faced towards me so I can also see what
| they are doing.
| hibikir wrote:
| It's not just filing the X-rays. Back in the day, for a big
| crown you got yourself a full mouth cast, ship it away, and
| eventually you got a crown which hopefully fit. Today you get
| a much less invasive scan before the root canal. one after,
| and the 3d printer in the back creates a crown that fits.
| Much faster, cheaper and typically even more accurate.
| hulitu wrote:
| > Computers no doubt can improve things; a lot of it seems
| like a no-brainer. But I'm starting to doubt that they're
| there to improve things.
|
| They stopped the improvement around Win 10. Since then,
| everybody (Microsoft, linux, Apple - Google never had a
| wheel) is reinventing a worse wheel, regularly.
| acomjean wrote:
| Dental software is terrible as far as I can tell. I'm at
| school /practice were the staff cheered loudly when it was
| announced they were planning to upgrade or change vendors.
|
| I never saw such passion about software.
| WA wrote:
| Dentistry has changed in the last decades. If a dentist refuses
| to use useful computer things, I instantly wonder if they are
| also out of date with modern best practices. Better materials
| for infills and stuff like that.
| arethuza wrote:
| I'm in the process of having some dental implants done and
| the process is amazingly high tech - I was particularly
| impressed at the 3D model they created from CAT scans that
| they then use to position instruments during work - they
| attach something to my teeth to tell where my head is and the
| software guides where the instruments should go based on 3d
| sensors.
|
| Wouldn't surprise me if they went fully robotic for some
| things in the not too distant future.
| saagarjha wrote:
| I've been with my dentist for a while and in the last 10
| years or so I think they've updated their X-ray machines
| twice. It used to be a massive machine that was in a
| special room, which they'd use to take multiple photos of
| your face by wheeling around. Then they got a smaller one
| that could be right next to your chair, and they'd make you
| bite down on some film while they moved an arm around with
| the source on it. Recently they have a new machine that you
| put your head in and it just seems to do the whole thing in
| one pass.
| arethuza wrote:
| I did ask a dentist once about why the roots of my wisdom
| teeth were so strangely distorted in an X-ray and they
| carefully explained that there was no distortion and they
| really were that shape...
| maxerickson wrote:
| The head thing might not be doing the same x-ray as the
| bite thing.
|
| I'm impressed they only got the bedside one recently. My
| dentist just recently upgraded to direct digital sensors
| for their x-rays (wires to the computer in the room
| instead of digital plates), but the X-ray source shows
| decades of battle scars.
| scythe wrote:
| >Better materials for infills
|
| My mother is a dentist on the verge of retirement who used to
| fly to conferences all the time and ran a reasonably
| successful dental practice with about a dozen employees (and
| plenty of computers). She would always talk about how the new
| implant ceramics are not as durable as the old amalgam and
| they're only popular because they're white instead of gray.
| epidemiology wrote:
| Not sure what being personable has to do with knowing how to
| use a computer.
| dijit wrote:
| could it be that wasted time and added stress make you less
| empathetic?
| the_d3f4ult wrote:
| This has nothing to do with "knowing how to use a computer."
|
| Looking at a screen while you check through dozens of flags
| and billing related documentation instead of looking at the
| patient is much less personable.
| kevml wrote:
| I can see that working today in dentistry more so than general
| practice. I've got medication that insurance has dictated that
| I need to refill a weekly med monthly and it arrives precisely
| the week I need to take it. I need to time my vacations around
| this med now.
|
| I get that I'm ranting against healthcare and not doctors, but
| I'd run far from any doctor that's paper only these days.
| jstummbillig wrote:
| Why would my care be better if a doctor goes through a paper
| folder instead of a digital one?
| mattkrause wrote:
| It's not how the records are kept per se.
|
| It's that the paper-using doctor can spend more time on you,
| the patient, instead of fighting with a balky UI and inane
| business rules.
| jstummbillig wrote:
| Why would that necessarily be the case? I understand that
| bad software can get in the way of anything, but I find it
| hard to imagine there is nothing out there that actually
| helps any given (and willing) physician to improve their
| work, and make more time for patients, not less. There are
| inherent properties to IT that can help make stuff more
| efficient across any domain I can think of, and physicians
| work checks a lot of the marks.
|
| I happen to work in the medical field and while a lot of
| the software involved has its issues, not working with
| software, at this point, seems like a really bad idea, in
| terms of error prevention, performance and efficiency.
| yason wrote:
| Not necessarily, no, but empirically yes.
|
| Paper-shuffling used to be not a major issue in a
| doctor's work day. It was merely something that yes, sure
| you had to log new patient data and whatnot for
| reference, but you were mostly free to do the paperwork
| in a way that fit your natural workflow. Based on the
| doctors I know/knew, it was not a pain point. Yeah, you
| would sometimes have to fetch physical papers from
| somewhere instead of clicking yourself to the same
| information on the computer, but that was not a major
| issue. I'd say it was similar to a programmer who's
| waiting for an incremental compilation to finish: a minor
| moment out of actual work but nothing to fret about.
|
| After doctors' offices got digital then interacting with
| the computer specifically certainly became an issue which
| didn't exist before. At best, it was just a clumsy way to
| do the inevitable and at worst it became a major part of
| the patient visit, with myriad of odd tricks you had to
| learn about some particular computer software in order to
| accomplish your actual goals.
|
| If something that used to be normal part of work nobody
| thought twice about once become noted as a separate issue
| of the work day, something did change there. Sure, there
| are benefits too, but it's the friction points that you
| feel at work when you're trying to get other things done.
| Sure, software could be written to serve the user and not
| the other way around, but software rarely is -- no matter
| the profession, doctors aren't the only ones!
| formerly_proven wrote:
| My old family doctor used to have IBM terminals into the
| early 2010s, I'm fairly sure there was an AS/400
| somewhere in the back rooms where all the serial lines in
| their practice converged. Very fast system. Meanwhile I
| was at a specialist some time ago and they had to switch
| back and forth between notepad and the medical app,
| because you can't enter more than a few words at once
| into the app. So he would write everything that's not a
| drop-down in notepad then copy-paste it.
| the_d3f4ult wrote:
| I'm a physician. To understand why this is true you have
| to understand that the software is not intended to the
| make the physicians jobs easier or more efficient. The
| point of modern EMR's is to take every patient encounter
| and generate a list of billable codes that maps onto the
| encounter in such a way that insurance companies are less
| likely to send it back. The stuff like checking
| medication interactions is just tacked on as an
| afterthought. Through this lens everything else makes
| more sense.
| ajdlinux wrote:
| A relative of mine had to go back to their paper-only
| specialist a couple of months ago to get a prescription
| reissued because the specialist had omitted a mandatory
| detail from the (handwritten) prescription form and the
| pharmacist couldn't fill it.
|
| Meanwhile, I had a similar prescription, from a different
| specialist, who issues his prescriptions as either
| e-scripts or computer-generated paper scripts depending on
| patient preference. I suspect his practice management
| software would stop him from making this class of mistake
| entirely.
|
| I get why a doctor might prefer to avoid the computer, but
| I think my relative would have preferred their doctor not
| screwing up on something basic and wasting a significant
| amount of their time over better vibes in a consult.
| DontchaKnowit wrote:
| Ive had so many problems woth e prescribe. Half the time
| its "just not working right now" the other half they send
| to the wrong place, or they send to a pharmacy that
| doesnt have supply and you cant find out that theyre out
| of stock until they recieve the script. At which point
| you have to cancel and then contact your doctor to
| resend. Which can take several days. Whereas with paper
| prescriptions you just drive to the next pharmamcy.
|
| Theres pros and cons to both
| formerly_proven wrote:
| Well for one thing it's much less likely for someone to steal
| 36000 therapy files and extort people into suicide when
| they're stored decentrally on paper in locked cabinets
| instead of ~~the cloud~~.
|
| https://en.wikipedia.org/wiki/Vastaamo_data_breach
| markus_zhang wrote:
| Eh...I'm all in for doctors who can actually take emails than
| just phones. I fucking hate talking over phones. I don't need
| "family" doctor. I need a family "doctor".
| kstrauser wrote:
| HIPAA doesn't _exactly_ make that illegal, but it comes so
| close that approximately zero doctors would be willing to
| skirt that line and risk the enormous penalties if they guess
| wrong.
| nradov wrote:
| All major EHRs now have some sort of patient portal with
| secure (HIPAA compliant) messaging built in.
| kstrauser wrote:
| Sure, but patients don't want to sign up for yet another
| portal. Unfortunately, the methods they want to use may
| not be practicable options.
| junon wrote:
| If you're in the US this might be for a specific reason.
|
| If you're a medical facility that isn't digitized then you're
| not subject to many of the HIPAA privacy and security
| compliance rules. It's an exception they carved out to
| grandfather in older practices that weren't digitized.
|
| Many facilities stay "analog" in that way for that explicit
| reason.
|
| Source: used to be a certified HIPAA Security Officer, this was
| a topic at the certification seminar I attended.
| Aardwolf wrote:
| Then again, paper can't leak as easily as a database
|
| Are the security requirements of HIPAA good? (genuinely
| wondering: your data goes to tons of organizations, any of
| them could use a not properly secured database and leak it.
| And are the requirements good both in the technology and
| practices, as who's accountable?)
| junon wrote:
| I'd say they're not bad.
|
| Any data processing by a third party must be done under a
| Business Associate Agreement (BAA), which transfers
| responsibility under HIPAA with the same rules and
| regulations to the third party. There's always a chain of
| liability when processing PII, traceable back to the PCP
| (primary care provider).
|
| The regulations also leave things open ended in terms of
| specific ciphers etc, stating "industry standard"
| encryption at rest and in motion (i.e. transport security)
| must be used, for whatever definition of industry standard
| is correct.
|
| As for privacy, exfil of PII even in non-digitized
| establishments is still covered (hence why there is
| typically also a Privacy Officer appointed with a HIPAA
| complaint org, distinct from a Security Officer, both being
| actual terms and certifications being handed out by
| certification bodies). That covers general privacy and a
| much larger scope, and applies to any healthcare
| establishment - not just those who use computers.
|
| Cryptographic audit trail requirements, third party audits
| and reviews, a slew of other software certifications (some
| even from the government, such as Meaningful Use), etc all
| exist to help with that mission.
|
| As for who's accountable, it's always tied to the processor
| of the information, and "breaches", which are violations of
| either privacy or security policy, must be reported all the
| way back up the chain in a timely matter, and in the event
| the breach might cause risk of harm or disclosure, must
| also be reported to a regulatory body (I forget which), in
| which case the offending party must pay a fine. There's
| insurance for these scenarios, I forgot if it's compulsory.
| But it racks up fast, and IIRC you're liable in most cases
| for damages up to a ceiling, somewhere in the 9 figure
| range.
|
| What's more is that there's also Qui Tam lawsuits which, as
| I understand things, can be brought against an offending
| healthcare establishment by a whistleblower of sorts (i.e.
| a third party who observes a breach, without being part of
| the chain of responsibility (the healthcare establishment)
| nor affected by the breach) on behalf of individuals harmed
| by said breach. As far as I know, anyone can do this.
|
| IMO, for what it tries to do, I think it does an _okay_
| job. It 's a really difficult thing to generalize and
| standardize given not only the flux of technology but also
| the fact that you still want independent innovation in the
| space without regulatory overreach.
|
| (This is a massive oversimplification of my slightly
| outdated knowledge of this as I've been out of the US
| healthcare field for a while now)
| lostlogin wrote:
| I disagree. It's wasteful spending your day trying to read
| doctors hand writing. There are dozens of other issues that
| come from technical incompetence, but the handwriting one alone
| is a vast waste of time and money.
| donatj wrote:
| I've talked about it here many times, so I'll be terse. I really
| hate when I go to the doctor that they just sit there and type
| the whole time. Barely even look me in the eye. On more than one
| occasion I have had my doctor literally just Google my symptoms.
| Scoundreller wrote:
| > On more than one occasion I have just had my doctor literally
| Google my symptoms.
|
| There have been times I wished they would have done that.
|
| I expect them to be resourceful rather than know everything off
| the top of their head.
| abhisuri97 wrote:
| Med student here: oftentimes the attendings who are googling
| are usually doing it because the patient's symptoms don't fit
| with the most common illness "scripts" we develop in our mind
| and have ready for the 90% of patients who walk in the door.
| The google is a quick sanity check to see if these symptoms
| are within the range of "normal" for the most likely
| differential diagnoses (i.e. list of most likely diagnoses
| based on the patient's presentation).
|
| That or those symptoms are exceptionally vague or uncommon
| enough that they warrant a quick refresher on google for
| leads on additional questions we should ask of patients (the
| most common offender here is rashes/skin lesions imo since
| they can literally be a manifestation of super simple "oh you
| just changed your shampoo" to "you have a rare autoimmune
| condition"...asking a comprehensive history from patients can
| help determine what tests to order).
| taneq wrote:
| That's still way better than being told to take two Panadol
| and come back in the morning if your symptoms don't
| improve. I mean, 99% of the time it's a seasonal virus and
| that's all you could/should do, but 0.1% of the time it's
| meningitis and if you don't go to the ICU then you die.
| vnerissa272 wrote:
| and so here is the problem of personalised care in a system
| where you can see upwards of 30 unfamiliar people a day:
| sometimes patients would rather I look things up, and others
| hate the idea of me touching any sort of technology in their
| presence, and it's nigh-impossible to tell which they are
| until a good way through the interview.
| kijin wrote:
| Just replace typing with voice recognition, and you've got the
| perfect AI doctor already!
|
| Patient talks about symptoms, doctor returns a markdown-
| formatted prescription. Charge by the number of tokens.
| SoftTalker wrote:
| Soon we'll have the holographic doctor as seen in Star Trek
| Voyager.
| dguest wrote:
| Science fiction, particularly space operas, can be
| dismissive of doctors. Most of the time the "doctor" is
| just a diagnostic machine that gives miracle meds and maybe
| 3d prints new body parts.
|
| Maybe it's prophetic: authors saw the writing on the wall
| and decided a doctor is a glorified mechanic who works on
| the most boring machine around (which hasn't changed in
| 100k years). Or maybe authors just decide the space was
| better filled by an ex-space-ninja or similar.
| ethan_smith wrote:
| Medical scribes and ambient clinical intelligence systems that
| automatically transcribe doctor-patient conversations are
| addressing this exact problem, allowing doctors to maintain eye
| contact while still capturing necessary documentation.
| p1necone wrote:
| My experience as a software engineer tells me that there's a
| positive correlation between frequency of googling and caliber
| of engineer, I have no reason to presume that would be any
| different with doctors.
| dekhn wrote:
| All of my doctors for the last five years (Kaiser and Sutter)
| have no problem with their computers. When I switched from Kaiser
| to Sutter, the doctor showed me "how easy it is to transfer my
| full records" (they both have Epic, plus a custom integration). I
| have no trouble communicating while they use their computer, and
| handle just about everything through the captive website (which
| is a bit slow- sometimes the pharmacy faxes a request to my
| doctor, who ignores faxes until I ping them).
|
| The one important thing is to know how to work the system. Once
| you understand how it works, it's remarkably easy to guide your
| doctor or other service providers to do what you want. I talk a
| lot with the doctor and my spouse (who has taught me a lot), and
| I also read various online forums. Further I have no truly
| serious health problems that require intensive care, which could
| change things a lot.
|
| I understand many people feel differently, and I in no way want
| to invalidate their subjective experience- if you prefer paper,
| or find computer doctors impersonal, or anything else, I'm not
| here to try to convince you otherwise.
| shigawire wrote:
| The electronic system often benefits complex patients more than
| someone like you. All your relevant history could fit on a few
| pages.
|
| But if you have many illnesses, medications, and unclear causes
| - then having all the data documented and available to
| different doctors you may see is helpful.
| zabzonk wrote:
| For my xray stuff (broken ankle/leg and earlier badly broken arm)
| they all seem to love it compared with photographic plates. I
| like seeing it too, but of course they could do that with photos,
| but only after some time. Good to have it networked.
| golem14 wrote:
| I wish schools would stick to paper and pencil homework. Getting
| kids to stay on task using a computer is neigh impossible.
| CamperBob2 wrote:
| Yeah, it's hard to make them quit horsing around.
| lloeki wrote:
| I wish they were actively taught how to stay on task instead
| of being shamed into it.
|
| I mean they're being handed over / bring their own computer /
| have their phone at hand, and anyway they probably have all
| of that at home, and will have at work someday.
|
| From that state of affair the best thing to do is to try and
| give then the tools to best manage and navigate the
| situation, not yell "stay on task" at them (which is AFAIK
| basically the only course of action) which is wholly
| unproductive.
| tacostakohashi wrote:
| I bet it would be fine if they stuck to Windows 3.1 and MS Word
| 6, or DOS + Wordperfect 5.1 (with no network connectivity)
| which was approximately what I used for my homework.
|
| The problem isn't "computers", its the internet, and ads, and
| the fact that all "modern" stuff is just a thin wrapper around
| that.
| ljchen wrote:
| My personal feeling is that medical practices have not evovled
| too fast with computing. Electrical engineering, mechanical
| engineering, biomedical engineering etc all contributed a lot to
| how doctors treat diseases. But whether medical records are
| digitialized or not is not significant. It helps, but does not
| increase cure rate. Old fashioned doctors have good reasons to
| reject. But they do not say no to new medicine, new devices, new
| procedures.
| catgary wrote:
| Ehh, I think there's a pretty consistent pattern of doctors
| rejecting pretty basic technologies or procedures that lead to
| positive outcomes for patients if it's seeking to address the
| fact that doctors are human beings that can make mistakes.
| Medicine is a field full of massive egos.
| XorNot wrote:
| Yeah I mean let's keep in mind that the man who found hand
| washing stopped patients dying of infections was roundly
| ignored [1] for too long.
|
| [1] https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis
| marcyb5st wrote:
| I fully reject your statement about not digitizing being
| insignificant. And there are several reasons for it, but the
| main one in my mind is about prevention vs curing.
|
| In an ideal world where every medical record is digitized it
| would be possible to discover long term causal effects that
| nowadays we don't know because running long term studies is
| hard, costly, and in a world where publishing is everything
| they don't lend to it. So we explored and confirmed only the
| most obvious long term cause-effect connections.
|
| Therefore, it would enable prevention of some diseases for
| which we, nowadays, can only have a reactive MO.
| hulitu wrote:
| > it would be possible to discover long term causal effects
| that nowadays we don't know because running long term studies
| is hard,
|
| Companies sell the data to ad companies, before any
| meaningful research can be done.
| marcyb5st wrote:
| Fair, but I said "in an ideal world". Also, not sure if
| selling ads is more profitable to a product like a
| supplement because mining the digitized medical records
| showed that (example I pulled out of thin air) "constantly
| low potassium increases Alzheimer incidence by 50%" or
| similar.
| nradov wrote:
| Numerous companies have already tried and failed with this
| approach to medical research. Naively you might think that
| you could just suck in huge quantities of de-identified
| patient charts to find all sorts of useful correlations
| between diagnoses, treatments, and outcomes. But this doesn't
| actually work because the data quality is so bad: garbage in,
| garbage out. Doing useful medical research usually requires
| setting up strict protocols for data entry and patient
| follow-up.
| hulitu wrote:
| > My personal feeling is that medical practices have not
| evovled too fast with computing.
|
| You should see "computing". Resizing a window in Windows has
| become a lost battle. Working with files on Android is a
| torture. I really hope that "medical practices" will not
| "evolve", like "computing" has.
| jayd16 wrote:
| Something my doctor friends remind me of from time to time is how
| disconnected their actual workflows are from whatever system the
| money folks decided to buy.
|
| People making the purchases are not the ones using the system and
| they hate it because it doesn't serve them... A tale as old as
| time.
|
| For example, one of my doctor friends mentioned he has to scroll
| past an "order birthday cake button" at the top menu level so he
| can get to the order tests section and drill down to actually
| order tests.
| sfn42 wrote:
| I'd order birthday cakes daily just to prove a point
| Y_Y wrote:
| You may be pleased to know that you can do this via the GDS
| system for meal preference when booking flights by using the
| code CLML ("celebration cake meal") if your travel agent is
| cool.
| dotancohen wrote:
| 1. He's paying for the cakes.
|
| 2. You're improving the metrics of the people who put it
| there.
|
| A better strategy would be to call the support desk stating
| that you can't find the order tests section. Then when they
| tell you where it is, state that you assumed you were in the
| wrong menu due to the presence of the obviously unrelated
| order cake button.
| bboygravity wrote:
| Does product support talk to the developpers department
| though?
|
| In most companies I worked at it was like they deliberately
| made it hard for those departments to communicate.
| dotancohen wrote:
| > Does product support talk to the developpers department
| though?
|
| Probably not. But most likely, metrics flow up to their
| common PM.
| samplatt wrote:
| I read elsewhere on HN - "Well-meaning users will always
| quickly turn an unusable secure system into a usable insecure
| system."
| short_sells_poo wrote:
| The corollary is that a perfectly secure system is one which
| is completely and utterly inaccessible to anyone, including
| the users.
| mr_toad wrote:
| If the system is unusable some well-meaning user will set
| up their own system, which is unlikely to be secure.
| FuriouslyAdrift wrote:
| Hey now, don't knock on batch processing systems.
| freedomben wrote:
| I always like this when explaining why the A in the CIA
| Triad matters: The most secure computer is one powered off,
| encased in cement, and dropped into the middle of the
| Pacific Ocean. But it's not very useful
| kstrauser wrote:
| "A ship in harbor is safe, but that is not what ships are
| built for."
| lazyasciiart wrote:
| That's how Jira works too.
| mexicocitinluez wrote:
| It's called selling to the C-suite.
|
| But it's not _just_ about money, its about compliance too. If
| you can tell a higher-up "Use my software and you'll never
| have to worry about another compliance issue" that's also
| pretty appealing regardless of how well it fits the current
| workflow.
| coffeefirst wrote:
| And the best part is you don't even have to be right!
| Telemakhos wrote:
| This is a symptom of a deeper problem in medicine, the
| subjugation of doctors. It used to be that doctors ran their
| own practices and were the Gotter in Weiss, the gods in white
| lab-coats. What they said was what happened, and healing
| patients was their purpose. Now, however, doctors are cogs in a
| much larger healthcare system run by suits for purposes that
| one suspects have more to do with money than medicine. If
| computer workflows are optimized for the suits rather than the
| doctors, that's a symptom of a problem whose other symptoms,
| like rampant price inflation, are yet worse.
| zukzuk wrote:
| My company builds software for medical office assistants, and
| our clients are typically doctor-owned clinics. We have
| literally the same problem, but one step down the ladder. The
| doctors are making the purchasing decision, but MOAs are the
| direct users. And ironically enough, we have often run into
| the same problem. Doctors often don't see the value in
| software that solves their subordinates' problems.
| HaZeust wrote:
| >"Doctors often don't see the value in software that solves
| their subordinates' problems."
|
| This was such a huge problem at my former company, Billit
| (getbillit.com), that our number 1 method on achieving
| clients was making such steep referral incentives for
| doctors, to their colleagues. We only needed one to make
| scale eventually happen, but the organic clients couldn't
| empathize with the workflows of their front desk - they
| didn't care.
| resource_waste wrote:
| >doctors are cogs in a much larger healthcare system run by
| suits for purposes that one suspects have more to do with
| money than medicine.
|
| Is that actually accurate? The American Medical Association
| (the Physician cartel/trade association) bribes/lobbies about
| equal as hospitals/owners.
|
| They also legally reduce supply using their private,
| unelected, ACGME.
|
| If we use lobbying numbers, they are just as obsessed with
| money as the owners.
| kyouens wrote:
| I am a doctor and I run a graduate medical education
| program. The constraining resource is generally funding,
| not limits imposed by ACGME. For example, my program is
| ACGME-approved for two trainees per year, but we have
| funding for one.
| ambicapter wrote:
| Who decides the funding?
| kyouens wrote:
| Funding is mostly controlled by the federal government,
| via Medicare and Medicaid, and if I am not mistaken the
| funding levels are set by Congress.
| nradov wrote:
| You are not mistaken. Contrary to the conspiracy theories
| you see on here about the AMA, lately they have been
| lobbying Congress to increase funding for residency
| programs because that is the primary bottleneck to
| producing new physicians.
|
| https://savegme.org/
| lesuorac wrote:
| So after studying for a decade a soon-to-be physician
| needs to go through a government funded job in order to
| qualify as a physician?
|
| Why don't the hospitals just pay the cost of their staff
| like every other apprenticeship program? (or add it into
| the list of student debt that doctor requires).
| nradov wrote:
| Anyone who graduates from medical school with an MD / DO
| degree needs to complete several years of graduate
| medical education (residency) at a teaching hospital in
| order to become a physician legally authorized to
| practice medicine. Most residency slots are funded by
| Medicare, although some are funded by other sources.
| Teaching hospitals are usually run by non-profit
| corporations, or by state or local governments. While
| internal accounting is always a bit fuzzy and opaque they
| simply don't have the money to pay residents directly.
| Most residents generate less revenue than they cost to
| train. And hospitals don't have the freedom to raise
| prices to cover the cost of running residency programs.
| Thus the need for subsidies.
|
| If we force prospective doctors to take on even more debt
| then we'll likely end up with an even worse shortage.
| Current levels of student debt are already unsustainable,
| at least for many specialties.
| lesuorac wrote:
| > Most residents generate less revenue than they cost to
| train.
|
| Is this just a thresholding issue? What substantially
| changes about the resident from year 1 to 3? Can you chop
| residency up into different tiers where they don't need
| somebody watching them do stitches once they're no longer
| the lowest tier?
|
| I find it extremely suspicious that a sector with so much
| money in it can't figure out how to make apprenticeships
| profitable but an electrician can.
| nradov wrote:
| You seem to be confusing amount of money with actual
| control. Electrical contractors can charge any price they
| want (subject to customer demand). Hospitals, especially
| teaching hospitals, have no such freedom. Medicare
| reimbursement rates are fixed by government fiat. This is
| not a free market.
|
| Residencies are already chopped up into tiers. Those with
| more experience have more clinical and administrative
| autonomy. But for the most part, Medicare doesn't allow
| hospitals to directly bill for work done by residents.
| With a few limited exceptions, all of their work has to
| be supervised and signed off by a qualified attending
| physician. This training and supervision is extremely
| expensive.
|
| Any major reforms will have to come at the federal
| government policy level. This is not a problem that
| medical schools and teaching hospitals can solve by
| themselves.
| s1artibartfast wrote:
| I think it is primarily a matter of insurance
| expectations and regulation of residents. It dictates
| what services they can bill for and the amount of
| redundant oversight required.
|
| It is a self imposed problem.
| nradov wrote:
| The problem is largely imposed by Congress in terms of
| strict rules about what hospitals are allowed to bill
| Medicare for. This is not something that teaching
| hospitals have imposed on themselves.
| s1artibartfast wrote:
| correct, I didn't mean to imply it was by the hospitals,
| although the teaching hospitals may still benefit from
| the current arrangement.
| resource_waste wrote:
| Uh... You are talking about the highest paid profession
| in the US.
|
| There is no debt problem.
|
| I joke about how bad doctors are at math, but this is a
| pretty obvious case when Physicians are making
| 200-500k/yr and complaining about 300k of debt.
| lesuorac wrote:
| 300k of debt sounds kinda low.
|
| https://www.bls.gov/ooh/healthcare/physicians-and-
| surgeons.h...
|
| > 2024 Median Pay This wage is equal to or greater than
| $239,200 per year or $115.00 per hour.
|
| > Physicians and surgeons typically need a bachelor's
| degree as well as a medical degree, which takes an
| additional 4 years to complete. Depending on their
| specialty, they also need 3 to 9 years in internship and
| residency programs. Subspecialization includes additional
| training in a fellowship of 1 to 3 years.
|
| So on ~240k you pay ~50k takes just to the federal
| government and we'll say 12k to the state. 178k is still
| pretty good, knock out 80k for living expenses (better
| not live on the coasts) and you're left with 90k which
| would (naively) pay down 300k debt in 4 years. That said,
| you're also probably 30 with a net worth of 0$ and
| could've done a different career path to make ~240k per
| year without a decade of education.
| nradov wrote:
| You're really missing the point. There is a huge variance
| in physician wages based on specialty and location, to
| the extent that looking at averages is mostly
| meaningless. We already have a growing shortage of
| physicians, especially primary care providers in rural
| areas. Asking prospective doctors to fund their own
| residency slots will only make that problem worse.
| resource_waste wrote:
| Why is the government paying for graduate education? I
| paid for my own graduate education.
| maxwell-neumann wrote:
| The costs would be utterly extortionate otherwise.
| FuriouslyAdrift wrote:
| At least in the US, many doctors (at least specialists) split
| off and created their own companies that then contract with
| the hospitals.
|
| A large chunk of people working in healthcare are all
| contractors, now, with all the overhead and friction that
| comes with that.
|
| The only true employees of most hospital systems are the
| finance people.
| korse wrote:
| and facilities, cops, 'environmental services' etc.
|
| Hospitals employ plenty of people to keep the machine
| running. No one wants a localized rainstorm in a surgery
| bay.
| freedomben wrote:
| Indeed, and something else many people don't know is that a
| lot of (mid to senior) doctors have ownership stake in the
| hospitals, or are part-owners of the building that the
| hospital leases, etc. So it's not a direct "owernship"
| relationship anymore, it's more like a stockholder who
| works (contracts) for the company, sometimes with a hop or
| two in the way. I'm not saying this is good or bad (it
| doesn't seem at all clear cut either way to me), but it is
| something I found really interesting
| jeffreyrogers wrote:
| A lot of that is to get around laws that say corporations
| can't practice medicine. These are state-laws, not federal
| so in every state it's different.
| tristor wrote:
| > Now, however, doctors are cogs in a much larger healthcare
| system run by suits for purposes that one suspects have more
| to do with money than medicine.
|
| Just one more way that private equity ruins the world.
| burnte wrote:
| > Something my doctor friends remind me of from time to time is
| how disconnected their actual workflows are from whatever
| system the money folks decided to buy.
|
| There are two ways EMRs get made. They start from the money
| side and grow into clinical, or they start in clinical and grow
| into finance. This means however they started, that's what
| it'll be strong in.
|
| I would absolutely love to get to help design an EMR. A huge
| part of my job is finding ways to help our clinical staff spend
| less time in the EMR and more with patients. There's so much
| room for improvement, but it's a hard market to crack.
| didgetmaster wrote:
| You are absolutely correct about it being a hard market to
| crack.
|
| My wife, who is a doctor, often complains that the various
| systems she has to deal with are often unusable.
|
| When I was designing my new, general-purpose data management
| system that handles both structured and unstructured data
| well; she begged me to try to come up with a better system to
| manage medical data.
|
| While I think my system has the potential to make a much
| better EMR; the work and money needed to break into that
| market felt beyond my reach.
|
| A little startup with a superior architecture, but without
| all the political influence and domain knowledge to navigate
| the medical world; has little chance of gaining a foothold.
| andrepd wrote:
| Also known as the Blackboard problem... It has to be the worst
| software I ever had the misfortune of using, because the people
| who choose it (admins) are not the ones who have to use it
| (profs and students.
| Melonai wrote:
| Also quite telling that when you go to Blackboard's (now
| called Anthology, apparently) site, 75% of it is dedicated
| solely to AI.
|
| You get a small blurb about "Experiencing the power of
| Together(tm)", whatever that could mean, some small product
| description, of course all "AI-enhanced" and then lots of
| fluff about "industry-leading AI capabilities",
| "responsible/ethical edtech AI", "AI roadshows", etc.
|
| So much ado about what's definitely just an annoying ChatGPT
| wrapper button that most will definitely quietly learn to
| ignore... :)
| andrepd wrote:
| It's a multimillion dollar business entirely dedicated to
| the enterprise of selling Blackboard to schools. With the
| side-effect of producing a terrible piece of software.
| davnn wrote:
| There appears to be (almost) no true competition in healthcare,
| therefore no real incentives to improve productivity. Wages in
| healthcare rise disproportionately without productivity gains
| (Baumols disease); why invest in digitalization?
| manmathmo wrote:
| Competition isn't the only way to hold down wage costs in
| healthcare. The UK system involves a combination of monopsony
| and economies of scale. (I make no other claims about the pros
| and cons!).
| the_d3f4ult wrote:
| Wages in healthcare have decreased Year-Over-Year relative to
| inflation since at least the 90's. Productivity has increased
| in terms of the number of patients seen / day.
| resource_waste wrote:
| I'm not sure where you got this information, but it does not
| apply to Physician services who have gotten 5% year over year
| increases in medicare reimbursements.
|
| Physical Therapists? Sure. But the American Medical
| Association is a fierce lobbyist.
| lifestyleguru wrote:
| Don't pity or excuse the doctors, they're smart and they know
| what they are doing. If their workflows with computers don't
| work, it's only because they make more money from this situation.
| anonymars wrote:
| Do you think every doctor is their own boss?
| hulitu wrote:
| > If their workflows with computers don't work, it's only
| because they make more money from this situation.
|
| Or because the workflows do not fit the situation.
| russellpekala wrote:
| Check out this blog for the best summary of why data has hurt
| medicine and insurance https://yuzu.health/blog/ai-will-not-fix-
| healthcare-admin.
|
| The company Yuzu is hiring too. Worth reaching out if you care
| about how to fix this issue.
| anon_cow1111 wrote:
| Me(2010 ish): _Hey can I get my x-ray pictures before I leave?_
|
| Doc: _No, there 's no way to get pictures off of this computer_
|
| I had the pictures saved on a flash drive about 30 seconds after
| he left the room. They were using some awkward browser-based
| system where everything was served as an html page. It was still
| quite concerning that someone that spent 4-8 in med school lacked
| even basic computer skills.Just a personal anecdote.
| gloxkiqcza wrote:
| It's even more concerning you obtained access to this system
| with ease. Sounds like a pretty serious security incident.
| lqet wrote:
| Wait - you accessed your doctor's computer _after he left the
| room and downloaded data from it_?
| amelius wrote:
| Makes you wonder if they could have accessed and saved data
| from other patients as well.
|
| "I topped up my bank account within 30 seconds after the bank
| clerk left the counter."
| teekert wrote:
| My experience as well, in a hospital a doc left me with sa
| fully logged in console, to feed my kid in his office (which
| is incredibly kind of course). I for one got that "walk afk =
| alt-f4" rammed into me at my work place at that time. Makes
| me think that there might be a face-id like unlock (and
| immediately lock) market out there for PCs...
| anon_cow1111 wrote:
| Sure did! I think you're vastly overestimating the security
| of... basically everything computer related in the 2010 and
| earlier era.
|
| I did not poke around obviously, because I was only
| interested in my personal files and assumed I only had a few
| minutes. Could I have been 'evil' and accessed other stuff
| maliciously? Maybe idk.
|
| Years before I also had root access to my entire school
| district's records and probably could have wiped them if I
| really wanted to. I'm not a hacker or programmer by any
| means, just a random idiot that figured out how to use
| ophcrack back when XP was the primary operating system. It
| was a different time.
| markus_zhang wrote:
| Albeit whatever others said, I think it's PERFECTLY fine that
| you did that just for your own record. I'm not being cynical.
| Getting my own medical records is far from easy and I don't
| give a fuck anymore.
|
| Will I do it? Probably not. But I salute all who does.
| saagarjha wrote:
| I wish people had basic computer skills too but I think it's a
| failure of software design if you expect a random working
| professional to know how to work around the lack of obvious
| functionality?
| jrvieira wrote:
| They probably just meant that protocol prevents them from
| giving you access to them.
| ben_w wrote:
| > It was still quite concerning that someone that spent 4-8 in
| med school lacked even basic computer skills.
|
| That doesn't surprise me, for the same reason I can't tell you
| what a metatarsal is without googling.
|
| What did surprise me, was that my dad had a home PC with
| internet for _years_ before realising that Google search
| results had a scroll bar -- it 's not like he didn't know how
| computers worked, before retirement he'd been working as a
| software developer for one of the big UK defence contractors.
| adammarples wrote:
| Metatarsals don't come up in your daily work. Using a
| computer is a constant daily task for a doctor. In this
| example he failed to use it properly and just said it didn't
| work instead. That's not really OK.
| itisokqqq wrote:
| Almost certainly saving the image was a violation of hipaa
| policy-- giving emr records without the proper logging/etc
| can get the doc fired. The patient had a right to their
| images, but it's like anything enterprise, getting it has
| to go through the proper channels.
|
| You can probably imagine the privacy problems if that image
| were saved out of the cache directory.
|
| I don't think criticizing doctors for not knowing you can
| right click save image as makes any sense because it's not
| an important part of their work.
| reginald78 wrote:
| Can't comment on Google specifically but hidden scrollbars
| mean I often don't realize a dialog has scroll bars until I
| reach out into the dark edges to find what I hope is there.
| Microsoft will even harness this as a dark pattern to hide
| options they don't want you to choose.
|
| Perhaps your dad simply expected to scrollbars to be visible
| like they initially were.
| ben_w wrote:
| This was before scrollbars got routinely hidden like that,
| it was in the mid to late 2000s. He retired in the late
| 90s.
| resource_waste wrote:
| The longer I live, the more I see Physicians as people who
| are bad at math and/or who have parents who are physicians.
|
| There are a few people that are nither, but I think its safe
| to say at least 50% of physicians qualify as this.
| lostlogin wrote:
| > years before realising that Google search results had a
| scroll bar
|
| If that happened now he would have never seen anything except
| adverts.
| rossant wrote:
| Sometimes I see almost only ads not on the first screen but
| on the first _page_.
| tasqyn wrote:
| Your flash drive must have been compromised. Every flash drive
| from med students are infected with viruses.
| glitchc wrote:
| You'd think they know better and practice safe insertion.
| dsego wrote:
| Imho, the first thing doctors need to learn (at least in my
| country) is to touch type. I've had it with 5 min exams
| followed by 15 minutes of pecking to type in the necessary
| forms. Multiply by number of patients in a day and it adds up,
| and it's prevalent, family doctors, dentists, specialists,
| nobody bothers to learn it. Gets tiresome when you know you're
| in the waiting room for a couple of hours because they are slow
| at typing.
| makapuf wrote:
| Touch typing for doctors seems a waste of time now that
| Dragon / Whisper / your phone can do Speech to text quickly
| and relatively reliably.
| ileonichwiesz wrote:
| Sure, let's send private medical data to a cloud server
| somewhere for processing, because a medical professional in
| 2025 can't be expected to know how to use a keyboard.
| That's absurd.
| roflmaostc wrote:
| Medical companies could self host their speech to text
| translation. At the end the medical data is also on some
| servers stored. So doing speech -> text translation seems
| just efficient and not too much worrying if done
| properly.
| theoreticalmal wrote:
| So you think the better solution to doctors not being
| able to try is for them to self-host a speech to text
| translation systems, rather than teaching doctors to type
| faster?
| pbh101 wrote:
| Their healthcare/IT provider like Epic would do it. And
| in fact some have already done it, from what I can see.
|
| Furthermore, preparing/capturing docs is just one type of
| task specialization and isn't that crazy: stenographers
| in courtrooms or historically secretaries taking
| dictation come to mind. Should we throw away an otherwise
| perfectly good doctor just for typing skills?
| ileonichwiesz wrote:
| Who is responsible when the speech-to-text model (which
| often works well, but isn't trained on the thousands of
| similar-sounding drug names) prescribes Klonopin instead
| of Clonidine and the patient ends up in a coma?
|
| These models definitely aren't foolproof, and in fact
| have been known to write down random stuff in the absence
| of recognisable speech: https://koenecke.infosci.cornell.
| edu/files/CarelessWhisper_E...
| nradov wrote:
| This isn't a speech recognition problem per se. The
| attending physician is legally accountable regardless of
| who does the transcription. Human transcriptionists also
| make mistakes. That's why physicians are required to sign
| the report before it becomes a final part of the patient
| chart.
|
| In a lot of provider organizations, certain doctors are
| chronically late about reviewing and signing their
| reports. This slows down the revenue cycle because bills
| can't be sent out without final documentation so the
| administrative staff have to nag the doctors to clear
| their backlogs.
| roflmaostc wrote:
| I imagine where the speech to text listens to the final
| diagnosis (or even the consultation) and summarizes
| everything in a PDF. Of course privacy aware (maybe some
| local hosted form).
|
| And then the doctors double checks and signs everything.
| I feel like, often you go to the doctor an 80% of the
| time they stare at the screen and type something. If this
| could get automated and more time is spent on the
| patient, great!
| regularfry wrote:
| None of those options are off-device.
| magicmicah85 wrote:
| Most EHRs are sending that text input to the cloud for
| storage anyway. Voice transcription is already a feature
| of some EHRs.
| devilbunny wrote:
| I can type quite well. I can also troubleshoot minor IT
| issues. Neither is a better use of my time than seeing
| patients.
|
| I'm in an unusual situation as an anesthesiologist; I
| don't have a clinic to worry about, so my rate-limiting
| factor isn't me, it's the surgeon. EMR is extremely
| helpful for me because 90% of my preop workup is based on
| documentation, and EMR not only makes that easy but lets
| me do it while I still have the previous patient under
| anesthesia. I actually need to talk to 95% of patients
| for about 30 seconds, no more.
|
| But my wife is primarily a thinking rather than doing
| doctor, and while she can type well, why in the hell do
| we want doctors being typists for dictation of their
| exams? Yes, back in the old days, doctors did it by hand,
| but they also wrote things like "exam normal" for a well-
| baby visit. You can't get paid for that today; you have
| to generate a couple of paragraphs that say "exam
| normal".
|
| Incidentally, as for cloud service, if your hospital uses
| Epic, your patients' info is already shared, so security
| is already out of your hands.
| kstrauser wrote:
| Macs have pretty decent on-device transcription these
| days. That's what I set up for my wife and her practice's
| owner for dictation because a whole lot of privacy issues
| disappear with that setup.
|
| The absurdity is that doctors have to enter a metric shit
| ton of information after every single visit even when
| there's no clearly compelling need for it for simple
| office visits beyond "insurance and/or Medicare" requires
| it. If you're being seen for the first time because of
| chest pain, sure. If you're returning for a follow up for
| a laceration you had sewn closed, "patient is in similar
| condition as last time, but the wound has healed and left
| a small scar" would be medically sufficient. Alas, no,
| the doctor still has to dictate "Crime and Punishment" to
| get paid.
| lostlogin wrote:
| > now that Dragon / Whisper / your phone can do Speech to
| text quickly and relatively reliably.
|
| It's less accurate and much slower than a human typist (or
| 3) typing dictated reports.
|
| Tested over years in an MSK radiology clinic.
| fsloth wrote:
| No. Just no. Teaching doctors touch typing is tending to the
| secondary symptom of the fact doctors should not waste time
| inputting routine data.
|
| What doctors need would be secretarial services trained in
| medical procedures.
| Cthulhu_ wrote:
| I think this is one of the use cases where speech-to-text
| and (AI) transcription tools would be useful. Of course
| ideally there'd be two people, one doing the medical stuff
| and the other then documentation, but health care is
| expensive enough as it is.
| patrakov wrote:
| > Of course ideally there'd be two people, one doing the
| medical stuff and the other then documentation, but
| health care is expensive enough as it is.
|
| In the 1980s USSR, every doctor actually had a nurse who
| did the paperwork. And somehow, healthcare was still
| free.
| nradov wrote:
| Medical scribes are a thing. Some provider organizations
| employee people who attend patient encounters and do all
| the EHR data entry in order to free up clinicians for
| higher value work. This generally works well, but it is
| expensive and payers don't directly reimburse for that
| service.
| lostlogin wrote:
| It turns out that peach to text is slower than dictating
| and having a typist type.
|
| The speed at which reports are dictated is incredible and
| even when familiar with the field it's hard to understand
| how the typists are getting it right.
| fsloth wrote:
| All the dentists I've ever visited have worked in
| doctor/nurse pairings. The nurse assists in operations
| AND is the data entry expert.
|
| I think it's just about bureaucratic faux-economical
| thinking infringing to doctors workspace cutting overall
| effectiveness.
| bboygravity wrote:
| What we need is a universal standard way to store all of
| our personal data on our phone and share whatever is
| relevant at whatever company/government at the touch of a
| button.
|
| Nor a secretary nor a doctor nor anybody should have to
| hand-type data that already exists digitally.
|
| I'm so mind-blown that this doesn't exist yet that I feel
| maybe I should try and build it. I have tried building the
| next-best thing: OCR based form filling, but hard to get
| far as a solo FOSS'er.
| shortrounddev2 wrote:
| Problem: there are 19 competing standards
|
| New problem: there are 20 competing standards
| bboygravity wrote:
| There are 0 standards for global sharing of all possible
| personal data. That I know of.
| fsloth wrote:
| " this doesn't exist yet"
|
| We have a national health database in Finland called
| "OmaKanta" (which translates to MyDatabase or something
| like that). It's not perfect but at least I can trust it
| with most of my health records, and it's accessible to
| all doctors working in both public and private sector.
| rolandog wrote:
| I wonder if the Solid protocol might be helpful here? [0]
| I must confess I haven't toyed with it so far, but I am
| looking for an excuse to try it out.
|
| [0]: https://solidproject.org/
| bboygravity wrote:
| Looks cool, but is more abstract/low-level than what I
| mean. Could maybe be used as a foundation for it though.
| nradov wrote:
| Many healthcare provider organizations have standard HL7
| FHIR APIs that patients can use to download their own
| chart records. There are a variety of apps that you can
| use to call those APIs.
| bboygravity wrote:
| Im talking about a standard GLOBAL way of sharing that
| exact same data AND all other personal data.
| nradov wrote:
| FHIR is a global standard.
| patrakov wrote:
| And by the way, when I was a child, even before the
| computers came, here is how it worked in Russia.
|
| The doctor was listening to my breathing, looking at the
| throat, asking me and my mother questions, and saying
| various medical phrases to her assistant, who was then
| writing them into my patient records (a thick paper
| notebook).
| fsloth wrote:
| This is how all the dentists work that I've seen. Doctor
| plus nurse. Apparently dentists have more agency over
| their work environment than doctors do.
| FuriouslyAdrift wrote:
| I used to do support for a service that did transcription for
| doctors. The doctors would call in and tell the medical
| transcriptionist what to type and they would do the input.
|
| It always seemed incredibly inefficient and expensive but
| hospital management told me this was the most dependable way
| to get accurate records and even a single lost lawsuit would
| cost more than the service.
|
| It's stupid, but that's the world we live in.
| dotancohen wrote:
| > It was still quite concerning that someone that spent 4-8 in
| med school lacked even basic computer skills.
|
| And how are your basic medical skills? Arguably, which one do
| you think it would be more important to cross pollinate to the
| other professions?
| oersted wrote:
| This points to a wider misconception that the public has.
| Computer engineers learn how to build computer systems, they
| don't learn how to use computer systems. Automotive engineers
| are not necessarily good drivers either, and an architect can
| get lost in your building just as well as anyone.
|
| Sure you get a lot of it through osmosis by spending a lot of
| time at the computer, but computer science professors
| struggle with projecting slides from the in-class computer
| just as much as high-school teachers.
|
| My point is that, sure, it's reasonable to expect a doctor to
| know absolutely nothing about programming. But if using
| computers is such a central aspect to their job, it's not
| unreasonable to expect that they will be proficient in
| operating medical computer systems, probably better than
| computer engineers.
| dotancohen wrote:
| I'm not talking about programming. I'm talking about basic
| use of a keyboard and mouse. You just expected other people
| will know how, yet have no basic knowledge of other
| professions, even those that are arguably more important.
|
| Do you have basic knowledge of your own body? Anatomy, for
| instance? I recently tore a rotator cuff, none of the four
| muscles mentioned I had ever heard of in my life. It would
| have helped me immensely had I not had to spend an evening
| googling what are actually basic medical facts.
|
| Or how many people who drive know what a catalytic
| converter is, or what symptoms are typical of it failing?
| Or even what to do when certain idiot lights light up on
| their dashboard? The check engine light comes on, do you
| stop on the side of the road or can you continue to your
| destination? Or can you continue, but just to a garage? Do
| you have to do so at reduced speed? How about if the oil
| light comes on? How about if the low tire pressure light
| comes on? How about if the airbag light comes on? How about
| if the battery light comes on? How about if the light with
| an exclamation mark inside a triangle comes on? How about
| the light that looks like a profile of the car with skid
| marks under it? How about the light with the cryptic three
| letters ABS?
| randallsquared wrote:
| > _I 'm talking about basic use of a keyboard and mouse.
| You just expected other people will know how, yet have no
| basic knowledge of other professions_
|
| That was their point: keyboard, mouse, and basic computer
| interaction is general knowledge that anyone in modern
| life should have, like first aid or what traffic signals
| mean (for both vehicles and pedestrians).
| krisoft wrote:
| > I'm talking about basic use of a keyboard and mouse.
| You just expected other people will know how, yet have no
| basic knowledge of other professions, even those that are
| arguably more important.
|
| I'm a bit confused about what you are saying. Basic use
| of a keyboard and mouse is not exclusively part of the
| software engineering or IT profession. It is in fact part
| of every job where as part of your job you use a
| computer. Which is almost every job nowadays.
|
| Same as writers are not the only people who are taught
| how to write, and accountants are not the only people who
| are taught arithmetics.
|
| > I recently tore a rotator cuff, none of the four
| muscles mentioned I had ever heard of in my life. It
| would have helped me immensely had I not had to spend an
| evening googling what are actually basic medical facts.
|
| Sorry to hear that, and I hope you are feeling better.
| Not really sure though what is your point. Are you saying
| doctors should not know about basic use of a keyboard and
| mouse because you haven't heard of the rotator cuff? Or
| are you saying that people should be also taught about
| the rotator cuff who are not doctors? I just don't really
| understand your point.
|
| > Or how many people who drive know what a catalytic
| converter is, [...] How about the light with the cryptic
| three letters ABS?
|
| I'm really not sure what your point is.
| dotancohen wrote:
| I'm saying that we should not expect people to use
| computers efficiently, rather we should expect people to
| use computers in a "good enough" fashion.
|
| I think that more cross-discipline experience would
| benefit everybody.
| glitchc wrote:
| Come now. You mean to tell me the same doctor doesn't use a
| computer at home, write emails, make an occasional document
| or spreadsheet for tax purposes, doesn't carry a smartphone
| in his pocket, text other people?
|
| A doctor is a human being, not a specialized insect.
| dotancohen wrote:
| He does all that. And for him, hunting and pecking is
| efficient enough.
| anon_cow1111 wrote:
| I know basic things like cpr, how and where to apply pressure
| to stop bleeding, signs of a stroke or hypothermia, you know,
| basic vital stuff to keep someone alive in case of emergency.
|
| Similarly, I'd expect a doctor to be familiar with things
| such as "save as" or "print screen" if they used a computer
| every day.
| ubermonkey wrote:
| Medicine is such an all-consuming pursuit that I'm entirely NOT
| surprised that a doctor might not have great computer skills.
|
| Not knowing how to pull an image out of a web page is not
| something that will impact their ability to diagnose your
| malady.
| tim333 wrote:
| My trick was to photograph the screens with my phone. A lot of
| the stuff wasn't html and genuinely quite time consuming to
| figure how to send.
| Havoc wrote:
| Corporations also set up stuff in rather hostile ways.
|
| I just spent 30 mins searching for the option to create a simple
| support ticket saying computer hardware on desk X broken.
|
| It's just layers upon layers of AI agents, help articles,
| automated systems, voice recognition etc to make it as hard as
| possible to actually get help from a human
| makach wrote:
| probably because doctors work with humans and computers are not
| humans.
| Abishek_Muthian wrote:
| Famous physician Dr. Abraham Verghese was telling in the
| freakanomics radio podcast that doctors now a days are behavinv
| like software professionals by being on their computers and ipads
| instead of touch the patient and looking for well-known symptoms
| physically like how doctors used to do.
|
| [1] https://freakonomics.com/podcast/abraham-verghese-thinks-
| med...
| dm319 wrote:
| As a doctor, I often get asked when I'm going to be replaced by
| AI, or if AI can help in my work.
|
| The reality is that our work efficiency could have been made so
| much efficient with a bit of decent user-friendly software that
| is optimised for the user.
|
| I also love computers and IT, but as a result I understand
| highly-optimised (usually open source) software.
|
| The proprietary system we have at work is a mess. Inconsistent
| widgets, some keyboard shortcuts for some dialog boxes, but not
| for others. Lots of forms that need filling that I shouldn't be
| having to fill out (it's the same every time but I have to go
| through the whole process just to speak to a patient over phone).
|
| As others have mentioned here, senior doctors used to look at the
| patient, and give their opinion. Admin and junior doctors would
| turn it into action in a safe way, following protocol and
| prescribing advice to make it happen.
|
| These days senior doctors are checking in their patients
| themselves, clicking through many menus to order blood tests,
| checking out their patients, writing their patient letters, and
| basically sorting out the majority of the admin for enacting what
| they recommended should happen.
| cainxinth wrote:
| I know the best doctor you'd ever have the privilege of being
| treated by. He's smart, kind, knowledgeable, experienced, and has
| a gift for noticing things others miss. I'd meet other doctors
| that knew him and they'd say he's the kind of doc they'd want
| treating their mothers.
|
| He has never been great with computers (though he often reminds
| me that he successfully created a boot disk with virtual RAM to
| run Falcon 3.0 on my IIGS when I was a kid). He's not totally
| incapable of using modern tech, but I am his tech support and we
| still occasionally deal with basic stuff like how to forward in
| gmail or save a PDF on his phone.
|
| I remember when his hospital switched to EMR. It was a nightmare
| for the first six months, but he eventually got the hang of it.
| Some of the other older docs requested assistants to help them
| but he was stubborn and prefers self reliance if he can help it
| and just gutted though it.
|
| That was years ago and I far as I can tell the doctors in his
| circle are very used to EMR now. I hear some are even liking new
| AI features that listen to an appointment and automatically draft
| notes (that the doc obviously must review and sign off on).
|
| My dad retired this summer after more than 40 years of 60-80 hour
| weeks saving and improving countless lives. He still struggles
| with computers, but I don't know much about medicine so it's more
| than a fair trade of advice for me.
| cyberpunk wrote:
| AI features that .. WHAT?
|
| How does that work? Are you saying that personal doctors
| appointments are being live transcribed by microsoft or openai?
|
| Over. My. Dead. Body.
| Knork-and-Fife wrote:
| At my last doctor's appointment the nurse asked if I was okay
| with AI conversation transcription and summarizing that the
| doctor uses. So I had the option to decline.
|
| I'm not sure how I feel about it yet. There are contextual
| details you might include when talking to your doctor that
| you wouldn't expect your doctor to write down into your
| medical record.
| Merad wrote:
| I doubt if they're using raw MS or Open AI models (because
| the whole thing would have to be HIPAA compliant) but yes,
| some doctors will now ask if you consent to them using AI
| tools to transcribe the appointment.
| lostlogin wrote:
| That ship has sailed. And that isn't the only use of AI in
| medicine. Radiology gets AI generated referrals that the
| referrer (apparently) reads before sending.
|
| The MR images has signal added by AI in k-space. Then the
| frequency domain data is transformed to images and AI doubles
| the resolution (Thanks Siemens deep resolve). Then PACS
| checks for various things depending on what radiology paid
| for (stroke, lung lesions, fractures, breast lesions).
|
| The report goes out, ready for your follow up appointment.
| cyberpunk wrote:
| In the US maybe, it seems normalised for people to run cctv
| inside their own homes even.
|
| Can't see it happening here (eu).
| darknavi wrote:
| > Over. My. Dead. Body.
|
| Maybe literally depending on where you end up dying.
| jama211 wrote:
| Honestly, what's the big deal? Before it was ai transcription
| they still used transcription a lot it was just algorithmic.
|
| If your concerns are about privacy, that's a seperate issue
| regardless, whether it's AI or not doesn't mean the data is
| being shared or not, and same with the transcriptions from
| before.
| cyberpunk wrote:
| Yes privacy.
|
| Maybe i'm just a crazy european but I find the concept of
| always on recording devices completely insane, let alone
| one in a doctors office.
|
| I dont see how that's a "separate issue" -- separate from
| what?
| hobofan wrote:
| There are hordes of startups working in that space, generally
| using HIPAA-compliant cloud services and/or on-device models,
| with different startups focusing on different
| specializations.
|
| I would count them among the most viable startups in the AI
| space (implementation-wise), and also among some of the most
| necessary with the aging population. They are also compared
| to other places where AI is trying to be employed in the
| healthcare sector on the "lower risk" side of things (doctors
| still are accountable, and the benchmark are the current
| badly hand-typed notes).
| cyberpunk wrote:
| Oh so the recording is being sent to a compliant service.
| That's okay then. I'm sure all these doctors practices with
| their creaky dusty monitor mounted windows 10 thinkstations
| absolutely can't be hacked or that the data could never
| fall into the hands of the government or anyone else.
|
| Bananas. Why are we letting this happen?
| indoordin0saur wrote:
| > EMR
|
| Elastic map reduce? The servers AWS provides for running big
| data processing tasks?
| derN3rd wrote:
| electronic medical record
|
| no more paper stuff so rather some software where they have
| to type all the details into the computer
| BjoernKW wrote:
| One rarely talked about aspect of this is that doctors -
| generally speaking - only trust other doctors. They won't buy an
| EMR system from someone without the necessary "street cred" -
| however well-designed that system is.
|
| I know of a large EMR software provider that went as far as to
| hire physicians as salespeople because having doctors talk to
| other doctors made sales a lot easier for them.
| freedomben wrote:
| Interesting! I think I ran head into this without realizing it.
| I prototyped a product for doctors at one point, and trying to
| even _talk_ to them about it was quite a slog...
| itisokqqq wrote:
| Is this really rarely talked about? In any field you have the
| leaders having to choose who they listen to. Dunning kruger is
| real, you have to have a way to separate the overconfident ones
| from the ones with actual clinical knowledge.
| tsoukase wrote:
| Ha, my whole life. I am a doctor with a CS degree.
|
| There is a fundamental neurological difference and deep mental
| incompatibility in the "technical" and "medical" way of thinking.
| You can NEVER be good in both simultaneously. When I am with and
| think about patients, I cannot use a PC (in the where-is-the-
| poweron-button way) and when I maintain my little Github
| projects, I become a dangerous doctor. My ability to change my
| brain with an "internal mental switch" has improved dramatically,
| it happens even in minutes.
|
| A great share of my income as a doctor comes from filling medical
| reports on various online platforms, covering 100000 people which
| my other five colleagues cannot serve. The platforms are not
| complex, just online forms that have a lot of copy-pasting and a
| bunch of clicks and up-downloads. The texts are so similar that I
| might try to automate/-fill them, most probably with a addon. I
| imagine they seem awful and scary to them and I don't blame them
| because it is painful to write a digital medical report and do
| anything else except... writing.
|
| I mostly choose being in the medical state of mind because there
| are emergencies I must confront. I do not serve any online
| project that would need immediate technical intervention -:) <==
| I am doctor, how do you create a smiling face?
| JayShower wrote:
| This stood out to me:
|
| > Indeed, the computer, by virtue of its brittle nature, seems to
| require that it come first. Brittleness is the inability of a
| system to cope with surprises, and, as we apply computers to
| situations that are ever more interconnected and layered, our
| systems are confounded by ever more surprises. By contrast, the
| systems theorist David Woods notes, human beings are designed to
| handle surprises. We're resilient; we evolved to handle the
| shifting variety of a world where events routinely fall outside
| the boundaries of expectation. As a result, it's the people
| inside organizations, not the machines, who must improvise in the
| face of unanticipated events.
|
| In this new age of AI, maybe we can start to reverse this trend?
| Make systems that can adapt and handle surprises, instead of
| pushing all this brittleness onto the humans using the system
| alexsmirnov wrote:
| I have been working at Kaiser Permanente for 5 years, and there
| were a lot of doctors pretty good with technologies. And they
| struggle with Epic, famous for bad UX as well. One doctor even
| created special windows application, where they recorded
| mouse/keyboard activity with Epic, and replay them on single
| button click. Same as anthropic "Computer Use", but in the
| traditional code. And it was written by doctor, not IT engineer.
| Later, I worked at startup that tried to create intelligent
| hospital bed, able to record patient heartbeat, respiration,
| movements without special sensors. The technical part was all
| good, but we failed to sell any such bed to hospitals, only a few
| to nursing homes. Doctors are conservative, plus anything related
| to medical requires a lot of certificates and compliances.
| Finally, we give up and made consumer device out of it - Sleep
| Numbers "smart bed". Companies who sell software to doctors spend
| much more efforts to satisfy all requirements, and make a deal.
| Investment in user interface quality does not make sense because
| all decisions made regardless of it.
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