David Mann is a retired cardiac electrophysiologist and blogs at EP Studios.
The storage capacity of the human mind is amazing. One estimate of the size of the brain’s “RAM” is as high as 2.5 petabytes (a million gigabytes). The number is based on the total number of neurons in the brain and the total number of possible connections per neuron. I suspect it is an overestimate, given the vagaries and innate inefficiency of biological systems. Nevertheless, the true figure …
Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures.
If you are a heart …
Compare the following two versions of the same medical history:
Version 1
CC: chest pain
Mr. Smith is a 57-year-old white man who comes into the office today for the first time with a complaint of chest pain. He states he has been in generally good health in the past, though he has smoked about 40 pack-years and admits to not exercising much, other than occasional games of golf. He has trouble keeping …
Carrie Fisher’s sad, premature death is an occasion to reflect upon the poor job the news media does in reporting medical news. The initial report from TMZ had the headline “Carrie Fisher Massive Heart Attack on Plane.” If one equates “heart attack” to the more precise medical term “myocardial infarction,” as is usually done, then this is certainly diagnostic overreach on the part of TMZ. From their report, …
I remember the disdain some of the EHR trainers had for their trainees back when our hospital system “went live” several years ago. Of course, this disdain was tempered by their knowledge that if docs weren’t so computer illiterate, or the user interfaces of the EHR systems weren’t so awful, or if the EHR software wasn’t so bug-ridden, their jobs wouldn’t exist.
So they soldiered bravely on, undaunted by grumpy old …
He was the last. Old and wizened, he counted down his final days, his final hours on earth. He lay in his bed, the rain drumming monotonously on the window. Night came. He pressed the button to call the aide. The aide appeared at his bedside. Every night, the old man had the same request. The aide went to the window and briefly pulled aside the curtains. He peered outside. …
Reading about the opening of the Noah’s Ark Theme Park in Kentucky brings to mind the days when I worked as a physician in that state. I had moved from an academic position in Colorado and joined a large group of private practice cardiologists in Louisville. I found that people in Kentucky were different from those in Colorado. They were much more overtly religious.
As an interventional electrophysiologist, I would meet …
“I love you,” she said as she was leaving the room.
“I, I um …”
“Not you. Your computer.” She cast my computer, still warm and glowing with its brilliantly colored logout screen, a glance of longing and desire, and left the exam room.
“Oh, I thought …”
The slamming of the exam room door clipped off whatever the end of that sentence might have been.
I sat down and rolled my chair over to …
Dr. Lisa Rosenbaum has an excellent piece in the NEJM entitled “Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine.” In essence a review of Dr. Robert Wachter’s book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, it deals with the ever increasing intrusion of the digital-industrial medical complex on the practice of medicine. Bottom line: Electronic health records …
I recently read an article in Politico entitled “Doctors barred from discussing safety glitches in U.S.-funded software.” The article states that, despite massive public funding of electronic health records (EHR), the EHR corporations (including Epic Systems, Cerner, Siemens, Allscripts, eClinicalWorks and Meditech) routinely attach gag clauses to contracts with the hospitals and medical groups who purchase their systems. We are talking about gag clauses that prevent criticism by …
If you want to know who the best surgeon in the hospital is, ask the surgical nursing staff. If you want to know who does the best job opening up coronary arteries using catheters, balloons, and stents, ask the cardiac catheterization lab nurses and technicians.
Unfortunately, these approaches to comparing physicians’ skills are only available to hospital personnel. They are the only people who are …
Times change, and, as with Darwinian natural selection, those who adjust survive and those who don’t perish. Henry Ford’s assembly line greatly ramped up the production of automobiles but put many people out of work. The elevator operators of my childhood are long gone. Those who have embraced new technology have usually thrived; those who have fought it or failed to understand it have suffered. Witness the success of Amazon versus …
A lot has been written about how awful electronic health record (EHR) systems are. They are overwrought, overengineered, dreadfully dull baroque systems with awkward user interfaces that look like they were designed in the early 1990s. They make it too easy to cut and paste data to meet billing level requirements, documenting patient care that never happened and creating multipage mega-notes, full of words signifying exactly nothing.
They have multitudes of …
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My lifetime has spanned many of the important developments in the Age of Computers. Back in 1969 when I entered college, I was a frequent visitor to the Kiewit Computing Center, the lair of a GE-635 computer that filled several rooms. Students had access to the computer via noisy teletypes and a multiuser operating system known as Dartmouth Time Sharing. We wrote simple programs in BASIC, a language created by two of …
I’m getting to the point where I think it might be time to stop or at least decelerate the pace of my writing on medicine. When I retired from medical practice almost a year ago there were a lot of pent up experiences that I felt a need write about. But now I have already written about almost everything that I wanted to and, as I am no longer a practicing physician, …
The idea of starting over with computerized electronic health record (EHR) systems and doing them right as mentioned in a previous post has struck a resonant chord. Unfortunately designing an EHR that works may be a fantasy, due to one huge hurdle that would have to be overcome first. But it is fun to imagine an alternative universe where EHR systems were patient-centric instead of being …
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The first “wild” Ebola case in the United States has occurred in Dallas, Texas. The patient, who is from Liberia and had contact with a pregnant Ebola victim in his native country, was initially sent away from the emergency department (ED) of a Dallas hospital after reporting there with viral symptoms. He told the triage nurse that he had just arrived …
With the recent discovery of the ShellShock vulnerability affecting a large number of computers, the question comes up again: How secure is medical data? Thanks to the federally mandated push to transfer medical data from paper charts to computer databases, most if not all of this data is now fertile ground for hackers. As pointed out in this article medical data is more valuable to hackers than stolen credit cards. …
There are now so many rules and regulations in medicine that it is difficult for doctors to express any individuality. Like the burgers at McDonald’s that are constructed in such a way that they taste the same regardless of your locale, doctors are expected to behave similarly when confronted with similar circumstances. Or at least that is how the proponents of algorithmic medicine see it.
In addition, electronic health record systems create uniformity by enforcing …
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As a recently retired physician, I still maintain an interest in medical research, though I have to ask myself: Why? Surely not just from the point of view of a potential future patient. But not from the point of view of a practicing physician either. Perhaps I keep up just from a lifetime of habit? Or is there something I miss about my old job?
These thoughts came to mind as …
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