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on the state of medicine, 2008

Wednesday,  10/01/08  07:57 PM

I've been sick, so I visited my doctor.  Being a patient is a unique experience for me, I never get sick, and when I do, I take a DayQuil or Motrin, and two days later I'm fine.  My doctor is the guy who conducts my annual checkups, annually.  As a result of my really lightweight brush with the state of medicine in 2008, I have a few observations.  These are not earth shattering and for those of you who have dealt with medical practice as a patient rather than a vendor, probably all too familiar.

First, there is really lousy communication.  My doctor is a GP, also involved in my case are a pulmonary specialist, a radiology lab, a lab where the blood analysis was done, and two pharmacies.  They are all colocated in one wealthy city.  You would think these entities would have an electronic way to communicate, but they don't.  Many phone calls are made, many faxes are sent (faxes!  In 2008!), and many data are manually transcribed.  Prescriptions are handwritten!  Worst of all, they all rely on me, the patient, to be the central repository of my information.  The pulmonary specialist asks me for my medical history, in great detail, when it is already sitting in my GP's files.  He asks me what drugs were prescribed, when the prescriptions were made by the GP.  The radiology tech asks me to describe my symptoms.  The pharmacy interprets a handwritten prescription.  The lab results are phoned and faxed.  Etc, etc.  In the case of a 49-year old with reasonable mnemonic capacity, these questions can be answered (although I could easily mis-remember drug names and dosages).  But what if I was older, sicker, less able to comprehend?  There is no excuse for this.  I have to believe a huge amount of efficiency could be gained and a large number of errors eliminated by some kind of physical repository for each person's medical history.  A thumb drive, for example.  We could carry them around with us from doctor to doctor, doctor to lab, doctor to pharmacy, with the requisite information stored and history updated.

Please someone!  Insert business plan here!

Second, the level of medical technology is amazingly uneven.  My doctor has a device the size of a shoebox used for measuring blood oxygen.  The pulmonary specialist has a similar device for a similar purpose, but it is the size of a large clothespin.  My doctor's nurses use their wristwatches for measuring pulse.  At the hospital, they have a device which clips to your earlobe, takes two seconds.  The hospital's X-ray machine writes film, which they digitize to store in their PACS (computer system).  My doctor actually asked me to drive to the hospital to pick up the film to take to the pulmonary specialist.  When I expressed shock that they weren't able to share the X-rays digitally, he expressed shock that doing so was possible.  (It was :)

It isn't just the technology, of course, it is knowledge of the technology.  Doctors spend a great deal of time doing CME (continuing medical education), but it seems to be disease and drug oriented, rather than technology oriented.  Maybe the doctors themselves choose this, I don't know.

Third, my doctors, labs, pharmacies, etc. do not share information with me, despite the fact that each of them seem to rely on me, the patient, to be the central repository.  The labs don't send me results, they send them to my doctors.  The pharmacies don't tell you about the drugs they make for you, or the devices they sell you.  The doctors consult with each other, but not with me.  It is like they all get together and collaborate on a diagnosis and treatment, and only then can the secret be revealed, as a single ground truth.  I am certainly not an expert in lung infections and would not presume to contribute to a discussion of possible diagnoses or treatments.  But there is some amount of debate, clearly, and I am not exposed to it.  Knowing that the radiology lab found X, and that doctor Y thinks this means Z, but doctor Q thinks this means R, that would be nice.  I do appreciate, medicine is sometimes art as well as science.

Enough!  I am complaining, but I should be grateful, because I do have access to the best in medicine, 2008, from doctors to labs to pharmacies, as a result of which I am feeling frisky enough to blog.  And that's what is really important!