Perspecitve <> Intelligence

Dave's quote below is important – and a point I often try to make when working with software developers and patients alike.

Scripting News: 2/5/2007

I think many times when you know something that other people don't — it's simply because you're standing some place where you can see something that you can't see if you're standing somewhere else. It's not because one person is smarter, or somehow better than others, it's just a point of view that's making seeing possible.

Because I am a physician – I have a certain perspective.  It's a product of my learning, my experiences, and (yes) my biases.  My perspective isn't better than yours – it's just different.  I'm not smarter because of this perspective.  

I learn from patients all of the time – since they have different perspectives that teach me things.

I don't speak Japanese.  That doesn't make me stupid – it just means that I never learned how to do that. 

You didn't go to medical school?  OK .. then I had better explain things to you in language that you understand.  Would I tolerate a Japanese speaker describing something to me in Japanese if they knew I didn't understand?  No.  So why do people tolerate physicians using DosctorSpeak?  I don't get that.

Silly Sign: Computer It’s for staff use only

Here's today's  silly sign.  " COMPUTER IT'S FOR STAFF USE ONLY "  Huh?

btw .. I've had comments set to require my approval on the Docnotes server for about 6 months.  I couldn't keep up with the CommentSpam – so only rarely authorized comments.   I've now turned it off entirely.  Want to comment on a post?  Sorry – you'll have to do so on your weblog instead.  🙁

Today (and yesterday)  I'm using Windows Live Writer for blog posting .. hey .. not bad.    Let's think about how weblogs have evolved since Dave first released Manila.  Back then – "edit this page" was the innovation.  Then came Radio and of course the rest is history.  (Just for the record – I was one of the first users of Pyra – the predecessor of Blogger).  What makes this all fit together so well isn't just RSS.  RSS is the front side – how we GET the stuff of blogs. It was a great idea .. and .. yes .. I'll give Dave credit for evangelizing it and honing it and parenting it through its childhood.  But the "back end" is just as important.  I can use Windows Live Writer to create this because it supports the metaweblog API.  The cool part is that I don't have to know that.  I tell it the URL for my blog, I give it my username & password .. and poof – it works.  Just like flock works, or performancing or blogjet.

Now (sorry – I can't resist) .. This stuff is not rocket science.  That's the point.  The API is pretty clean – just like the Flickr API or the Google Calendar API (though I still have a little trouble getting Oncalls to post properly to Google – even though the same ical feeds work fine with 30boxes).   These web-based apps all work right because the developers made them open.

Now look at healthcare.  I wrote about something about a year ago – and I still think there is merit to this model.  Since PHRs are all the rage (they should be) - why can't we:

  • Post our "free-busy" schedules in ical format – and use a service like TimetoMeet to arrange appointments?
  • Send patients their lab results as RSS feeds (yeh – secure .. )
  • Set up IM portals for patients to ask questions of physicians/nurses (yeh – secure, logged to the EMR/PHR etc)
  • Send SMS appointment reminders.
  • Integrate with VOIP PBX, gtalk, etc.
  • more ..

All of the above could be done now, with off-the-shelf tools.  Just gotta plug it all in together. 

EHR 2.0 is the next level.  Let's open up the EHR APIs like Flickr, Google, Yahoo, Userland, and Six Apart have done.  Want to edit your chart notes with a web-based minimal editor?  Go for it.  Want a "smart" (formerly called "fat") client with all of the bells and whistles that your OS has to offer?  Go for it.  Want to interface with a PHR or "patient portal?"  Go for it.  What do we need to do this?  EHR API.  We need to think of healthcare applications as a set of interoperable parts built on a solid foundation.  Just as the Metaweblog API makes it possible for me to migrate away from MovableType as my primary editing platform – it permits SixApart to focus on providing the parts they do best (server side – in the case of MT) and opens up a new market for BlogJet or Performancing.  Where to start?  EHRVA?  Hmmm.  I'm not sure they're ready to think outside the box in this way.  See yesterday's post.  Can software vendors see beyond the next quarter's sales numbers?  (Can we blame them?  As my favorite boss once said:  "with no margin – there can be no mission.")  There's a start on the front side – with CCD finally coming together as a product of CDA and CCR … but the back side isn't there yet.  We need some leadership on this front.  Hmm.

<obligatory disclaimer>  This is my view and doesn't represent the view of anyone who is currently employing me or has previously employed me .. or will employ me in the future .. or any of my children, relatives or neighbors. </obligatory disclaimer>

What makes a good doctor = what makes a good plumber.

Medical Decisions are hard to make.  Even when they seem easy.  

I'd say that the TV show "House" is popular because Dr House seems to focus on giving patients what they need (honesty, transparency, certain treatments) and not necessarily what they want.   In his case – the difference between the two are entertaining.   Does that make him a good doctor? 

In real life – this is much harder.   There's ample evidence that physicians' decisions are based on many factors.  What's best for the patient is simply one of these factors. 

We've had a medical student working on our office recently – and it's been interesting to see my practice style mirrored in her eyes:

  • I "actually listen" to my patients (who doesn't?   I wonder …)
  • I spend lots of time with my patients (no wonder I come home late every day!)
  • I hear what they mean – not just what they say (the hardest part)

I re-told this story to her – in abbreviated form.  I posted it nearly 5 years ago – but the principles I tried to highlight then remain important yet under-represented on the Internet today.  Medical blogs are now far greater in quantity – yet I still think there are rather few of them  that express the transparency that the initial work a few of us were striving for back then.   There are so many competing interests – for our time, our money, and our attention.  Without good principles – I'd argue that there is no way for physicians to stay the course – and really make the best decisions for our patients.

The National Physicians Alliance is a relatively new organization that's building steam – based on good principles.  It's great to see an organization that is committed to "Advancing the core values of the medical profession: Service, Integrity, and Advocacy."   You can also read the NPA?s ISSUE BRIEF outlining reasons why physician prescribing data should not be made readily available to pharmaceutical companies.  The issue brief mentions describes how to opt out of pharmaceutical industry data gathering by enrolling in the AMA's Physician Data Restriction Program (PDRP).  Cool.  Check.  Done. 

Integrity is so important – yet so often suspect when there is opacity.  Exposing our patients to the uncertainties of our profession is a cornerstone of shared decision making – yet it takes so much more effort – and so much more time – I'm not surprised that so few physicians actually do it. 

The same goes for plumbers.  We had a "free" cleaning of our furnace performed by these folks last week.  The service rep called my wife at work and told her we needed a new humidifier element for $45.  He happened to have one.  Said OK.  We also needed a new solenoid for the humidifier for $89 "on order."   Turns out – I replaced the humidifier element about 6 months ago (should be done once/year) and the solenoid seems to work just fine to me.  You can listen to  his explanation – left on our voicemail.   Now -  look at the picture. Water running pretty well, if you ask me!   I filled an 18 ounce cup in under 30 seconds.  If that's a "very small amount of water" – I think Gary needs to go back to plumbing school.

Either Gary is stupid – or he's lying.  Either way – I can't trust him or his company ever again – as I suspect that he's got his interests above mine.  I could buy the solenoid (see link above) for $45 if I really needed one.  And I'm a little mad that he took my 6 month old humidifier element with him when he sold me the new one (it's the honeycomb thing in the picture).  Either way – he can't be trusted.

We need trustworthy plumbers, doctors, bankers, lawyers, software developers, etc.    The principles of the profession  must guide our decisions.  If not – we will always be distracted or seduced by the many other choices on our path.  Plumbers who invent problems, doctors who self-refer, and software developers focus more on the icing than the cake – all compromise their integrity in the same way – and will ultimately lose.