Michael R. McGuire is the author of A Blueprint for Medicine.

How fragmented records and poor tracking degrade patient outcomes

Policy
July 1, 2025

Medicine today is single-encounter oriented with documentation largely tailored for legal purposes rather than medical care. When an encounter ends, the physician must sign off the documentation and no further changes can be made; any corrections require another document that must also be signed off, but this is seldom done.

A further problem with current medicine is that many diagnoses are differential diagnoses instead of confirmed ones, which may be OK …

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How fragmented records and poor tracking degrade patient outcomes

A critique of interoperability, big data, and AI in medicine

Tech
March 27, 2022

Today medical records are developed for a single encounter (an outpatient visit or hospital stay). The medical records for an encounter are signed off at the end of the encounter and cannot be changed. An addendum medical record can be added later to correct misinformation in the encounter medical records, but this is seldom done.

This process enables medical documents to be legal recordings of what happened during each encounter. But …

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A critique of interoperability, big data, and AI in medicine

Selectively sharing genetic information in the future

Conditions
March 6, 2022

Communicating with relatives that they may share a gene variant that could cause disease is problematic. Maybe you do not want to share that information with other relatives. Maybe other relatives do not want to know about such information.

Examples of such gene variants are BRCA1 and BRCA2 that predispose women to breast and ovarian cancer and men for some forms of cancer.

Medical practice may make more use …

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Selectively sharing genetic information in the future

Medication management and how consultant pharmacists can help

Meds
February 22, 2022

Management of medications is sometimes handled sub-optimally, at least in the United States. At the extreme, physicians who prescribe multiple medications prescribe some medications that treat the side effects of other medications. This could be considered physician negligence in extreme cases.

An example was given in a class I took at UCSF (the University of California at San Francisco). UCSF physicians jointly provided remote advice for a physician treating a developmentally …

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Medication management and how consultant pharmacists can help

The importance of treating early treatment diseases

Conditions
February 3, 2022

Today, the practice of medicine mainly involves treating medical conditions after symptoms of the medical condition become obvious (e.g., setting a fracture or treating pneumonia), or preventing disease for a population of patients using a preventative that has few side effects (e.g., vaccinations, mammograms).

In the future, medicine will be more predictive and proactive. Medicine will be better able to predict that a disease will occur for an individual before there …

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The importance of treating early treatment diseases

A new boon for Big Data and patient care

Policy
January 13, 2022

Big Data in medicine is the data analysis of large amounts of patient medical information to improve medical care. Analysis of data may be used to pick the best intervention for a patient based upon care outcomes of similar patients or to evaluate physicians.

The primary source of patient medical information is patient medical records, where a medical record reports what happens during an encounter, where an encounter …

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A new boon for Big Data and patient care

Virtual organizations in health care

Tech
January 1, 2022

In almost all organizations, an employee has a supervisor responsible for guiding the employee in doing their job. This requires good communication between the two.

Currently, in medicine, especially during stays in the hospital, there is a similar relationship between physicians: The attending physician recruits the necessary specialist physicians to provide care for the patient and supervises their care. The difference is that this relationship is just for the patient, and …

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Virtual organizations in health care

More physician responsibility for patient care

Patient
December 9, 2021

Medicine today is single encounter-oriented, with the patient medical record structured to support one encounter at a time, where an encounter is either a single outpatient visit or an inpatient stay. The problem with this single encounter orientation is that it often takes a number of encounters to get a correct diagnosis and that care for a medical condition could extend over many encounters before the medical situation can be …

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More physician responsibility for patient care

A universal patient medical record

Patient
December 3, 2021

Today, most medical organizations have gotten away from paper medical records and use computerized electronic medical record systems (EMRs). The U.S. government has encouraged the use of such systems, no matter how large or small these systems are.

A current problem is that a patient may be seen in different medical organizations and have medical records in different EMRs. This has promoted the concept of “interoperability,” allowing one EMR system to …

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A universal patient medical record