Monthly Archives: April 2013

So Simple A Child Could Do It: Slide Rules vs. iPads

Checking in at the dentist's office

Checking in at the dentist’s office


When we walked into the dentist’s office, my kids ran straight up to the computer to check in for their appointments.  This was my first time to take them to the dentist as my wife usually drives them.  My son and daughter quickly entered their names on the touch screen, grabbed books, and took their seats.  Freed from manually registering patients, the front desk clerk monitored patient flow and welcomed everyone to the clinic with freshly baked chocolate chip cookies.

Later that day, I went to my doctor’s office where I signed my name on a clipboard and patiently waiting in the lobby as patients have done for decades.  His office has the same electronic medical record as mine, but his clipboard system has not changed in decades.  My clinic has an EMR with a web portal and secure patient email, but our patients still queue at the front desk to give  their information to a clerk.  At the gas station, I swipe my credit card and fill my gas tank without talking to another human being.  At the airport, I walk up to the kiosk, insert a credit card, and print the boarding pass for the flight I checked in to the night before.  We expect businesses to adopt the latest customer service technology and embrace their use while we keep our clinics in the technological dark ages, suspiciously questioning each new innovation.  We complain about the inefficiencies of our electronic medical records but are slow to adopt innovations to improve the efficiency and ease of our patients’ visits to our offices.  Are we so focused on our frustrations that we forget our patients?

Some of this skepticism is well founded.  For the past four years I have used the same EMR software I helped implement in my residency fourteen years ago.  I can do work but do not save time.  It still cannot talk to the hospital system so I do not have to look up the results of lab tests drawn five miles away. Although the computer file format that allows EMRs to communicate with each other has existed for years, I just read another editorial this morning lamenting the lack of interoperability between competing software products.  While I firmly believe that such technology can improve patient care, these benefits are far from inevitable.  In the United States, we believe in the goodness of technology like an article of faith.  If you don’t think that technology will make your life better, you must be old-fashioned – or tragically unhip.  Too often, however, we fail to adequately question whether the benefits the vendor promised are as good as advertised.

In a recent discussion thread, colleagues compared the latest fitness apps for their smart phones and GPS-based devices.  I have tried similar devices but have found an “old-fashioned” running watch to be far more reliable.  While I enjoy my smart phone, tablet, and laptop, I think we must still channel our inner Luddite by asking:  Is this technology really improving our lives as much as we think?  Are there unintended consequences we will regret in years to come?

On the other hand, we shouldn’t simply disregard potential benefits based on such concerns.  If my children can check in to their own appointments, why don’t we make this available for all our patients?  If my 80-year-old can learn to use secure email to communicate with me, why can’t you?  If my 50-year-old on Coumadin can check his own INR at home, email me the results, and adjust his medicine based on my emailed response, why don’t more patients adopt this technology?

Learning to use the iPad


My father learned engineering with a slide rule, was one of the first to use the “revolutionary” Hewlett Packard desk top calculator, taught himself DOS and Windows a decade later, and now is mastering the iPad. While he is not sure he likes how the screen orientation changes when he turns the it, I doubt he would give up his iPad for a slide rule.  Such technological changes are inevitable, but our responsibility is to ensure they benefit our patients.

The genie is out of the bottle and it’s too late to put him back.

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How Does It Feel To Treat Someone Who Repulses You?

This post about the April 15th bombings at the Boston Marathon comes from Jerry Abraham, MPH, a 3rd year medical student at UT Health Science Center San Antonio.

“The real question is…How does it feels to treat someone who repulses you? Not just someone who annoys you—anyone training or working in healthcare in an urban area treats plenty of the very annoying: drug dealers, pimps, prostitutes, thieves, and thugs, as well as embezzlers, defrauders, money launderers, and inside traders. Rather, what is it like to treat someone whose very right to exist strikes a passionate chord?

Some health care workers may come to feel infuriated or morally wrong. A sense even may arise from some staff that they are abetting an enemy and are somehow complicit in his crime.

Of course they are not. Similar to the provisions of the Third Geneva Convention, which dictate that even the most heinous war criminal must receive humane treatment, every ill person must receive proper medical care. But this approach should not arise from the fact that it is our contractual duty under the law and we want to keep our job. Rather, providing drama-free, professional care even under extreme personal duress demonstrates our one priestly quality—our humanity, the single trait that distinguishes us from the person whose inhumane actions have caused so much sorrow.

The legal dilemma facing medical staff is clear: the Emergency Room is compelled to treat everyone who enters the doors in need of emergency care.

In 1986, Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) to assure that patients in need of emergency treatment receive medically proper attention.

This law prevented patient dumping—the convenient refusal to care for the indigent demonstrated by certain hospitals looking for an exclusive, cash-and-carry clientele. Doctors and nurses, as employees of the hospital, have agreed to follow the hospital’s rules as a condition of employment.

In other words, though the issue of a morally objectionable patient has not specifically addressed, the law provides no room for personal choice—hospital staff must treat everyone—equally.”

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Don’t Get Mad, Get Even: Political Advocacy

Last December, after months of “planning to,” I finally got around to calling to my state senator to set up a meeting before the legislature convened.

“Hello, my name is Dr. Y, I am a constituent and I would like to set up a meeting with Senator X in the district.”

“You know the session starts in 3 weeks.”

“Yes, I do”

“You know Christmas is in 2 weeks.”

“Yes, I do.”

“You know she’s very busy.”

Yes, I do.  I will be at the Capitol on the first day of the Legislature.  Is her legislative aide for health affairs available instead?”

“Yes.  I will ask her to contact you to set up a time to meet.”

When I met with the legislative aide several weeks later, we had a productive conversation.  She had worked on health affairs for another state senator before.  I pitched our bill to restore funding to family medicine graduate medical education and the physician loan repayment program to help place doctors in underserved areas.  We had been instructed to ask our senators to support the bill and cosponsor it if possible.  I thought, ‘What the heck, nothing to lose by asking.’  I was told that the Senator was interested in health care issues and she would get back to me with the senator’s answer.  I also forwarded a map of the senate district with all the medically underserved areas and primary care physician to population ratios labeled.

A few weeks later, she emailed me to say that the Senator had decided to support the bill.  Ok, I thought, she’ll vote for it when it is heard in committee.  A few days later I saw that she was listed as a cosponsor!  With 2 of the committee members listed as cosponsors, our chances of getting the bill out of committee looked much better.

Politics can be frustrating, but persistence pays off.  And you have nothing to lose by asking.

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