Just a simple vanilla blog site from a physician

There’s
a certain irony in that the more specialized a practice gets the more
technology there is available to help the physician. A retinal subspecialist is
a good example where they have in office orbital CT scanners and a host of
other extremely expensive tools available for the physician’s use at the time
of the visit.  On the other side of equation the primary care physician
who has to deal with the entire body and mind is often left with only a paper
chart, a stethoscope and devices that haven’t changed much in 100 years to
study the patient, derive a diagnosis and treat the patient.  The stark
reality is that this is completely backward!  The physicians needing the
most technology are those who are asked to treat the most conditions.

What’s
silly is that by the time a patient is seen by the subspecialist the diagnoses
have already been made (usually by other physicians higher up in the tree) so
the need for extremely expensive equipment is superfluous and supports
subsequent specialized treatments.

It’s
my opinion that if technology was available at the front lines many diseases
would be diagnosed, caught and treated long before they require subspecialised
therapy or treatment.

We’re
all familiar with the Tricorder was suddenly available only the
subspecalists would be given them and the physicians who would derive the most
benefit would be prohibited from using them either by
cost or reimbursement.

There
are many devices such as a dermatoscope, tonopen, digital o
phthalmoscope, otoscope, not to mention digital scales are
available but outside the reach of most primary care physicians.  Yet, if
each exam room was equipped with these digital devices AND connected to their
electronic medical records many diseases that now are missed could be diagnosed
earlier, more accurately and treated at a much lower cost than they are now.

On
the pure information front, I find the time cost of logging into multiple
systems (our own EMR and those of nearby hospitals, reference labs not
interfaced without our system, imaging
centers, online reference sources such
as UpToDate,
ePocrates,
MDConsult
an
d a host of other tools that I wind up using in the exam room prevents me
from exploiting them in the typical 10-15 minute appointment. Even though
we’ve equipped the PCs in each exam room with 21” swivel monitors we find
there’s a lot of visit time that could be saved if the all of the information
needed at the time of the visit didn’t need to be navigated to.

When
not seeing patients I usually grab all of the computers to which I have access,
splay them up in front of me (including one of the units from the nearest exam
room).  Productivity increases
dramatically.  Most information
resources are at my fingertips in parallel rather than serially if restric
ted
to a single machine or reduced screen real estate.  This is exactly why traders in most brokerage houses sit
behind multiple displays in order to work.  Time is money and faster, better (well, maybe) are made if
one doesn’t have to
waste time navigating to that information.

So
what am I saying?  

I
am confident that if we would put the most technology possible into the hands
of front line physicians who have to address the broadest spectrum of patient
concerns we might be surprised at how much more efficient, productive and cost
effective healthcare would be.

So
one day I see myself practicing in a room with all of the tools at my and my
patient’s fingertips.  Any
questions could be quickly answered, the record would not have to be populated
with vague text but actual images of the pathology observed, sophisticated
imaging and testing could be accomplished at the point of care before the
patient left the room. The patient and I would have a very good understanding
of the next steps rather than waiting for all the ordered tests to come back as
the patient is sent across town f
or them, paying higher and higher prices the
closer we get to the definitive diagnosis.

And
then I
wake up only to have had a wet dream.  I have to return to the small,  cramped, jail-cell exam room with the
one computer and a variety of relatively low-cost analog devices and try to
answer difficult questi
ons. Often having to disappoint the patient by sending
them on to another person or facility to eventually get to their answers.

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