There's a certain irony in that the more specialized a practice gets the more technology available to help the physician. A retinal subspecialist is a good example where they have in office orbital CT scanners and a host of other extremely expensive tools available for the physician's use at the time of the visit. On the other side of equation the primary care physician who has to deal with the entire body and mind is often left with only with devices that haven't changed much in 100 years. Yet they are expected in the usual 10-15 minute visit to interview, examine the patient, derive a diagnosis and treat the patient.
The stark reality is that it is the primary care physician, with the greatest informational needs that should have most of the tools.
We're all familiar with the tricorder used in Startrek where Bones could scan a person in the field as well as the exam room, view the images and make a diagnosis.
What's silly is that by the time a patient is seen by the subspecialist the diagnoses have already been made (usually by several other physicians who have sequentially seen the patient at an ever increasing cost). By the time the patient gets to the highest technology it is used only to confirm the diagnoses and to complete the definitive treatment.
It's my opinion that if technology was available at the front lines many diseases would be diagnosed, caught and treated long before they require subspecialised therapy or treatment.
There are many devices such as a dermatoscope, tonopen, digital ophthalmoscope, otoscope, not to mention digital scales are available but outside the reach of most primary care physicians. Yet, if each exam room was equipped with these digital devices AND connected to their electronic medical records many diseases that now are missed could be diagnosed earlier, more accurately and treated at a much lower cost than they are now.
On the pure information front, I find the time cost of logging into multiple systems (our own EMR and those of nearby hospitals, reference labs not interfaced without our system, imaging centers, online reference sources such as UpToDate, ePocrates, MDConsult and a host of other tools that I wind up using in the exam room prevents me from exploiting them in the typical 10-15 minute appointment. Even though we’ve equipped the PCs in each exam room with 21” swivel monitors we find there’s a lot of visit time that could be saved if the all of the information needed at the time of the visit didn’t need to be navigated to.
When not seeing patients I usually grab all of the computers to which I have access, splay them up in front of me (including one of the units from the nearest exam room). Productivity increases dramatically. Most information resources are at my fingertips in parallel rather than serially if restricted to a single machine or reduced screen real estate. This is exactly why traders in most brokerage houses sit behind multiple displays in order to work. Time is money and faster, better (well, maybe) are made if one doesn’t have to waste time navigating to that information.
So what am I saying?
I am confident that if we would put the most technology possible into the hands of front line physicians who have to address the broadest spectrum of patient concerns we might be surprised at how much more efficient, productive and cost effective healthcare would be.
So one day I see myself practicing in a room with all of the tools at my and my patient’s fingertips. Any questions could be quickly answered, the record would not have to be populated with vague text but actual images of the pathology observed, sophisticated imaging and testing could be accomplished at the point of care before the patient left the room. The patient and I would have a very good understanding of the next steps rather than waiting for all the ordered tests to come back as the patient is sent across town for them, paying higher and higher prices the closer we get to the definitive diagnosis.
And then I wake up only to have had a wet dream. I have to return to the small, cramped, jail-cell exam room with the one computer and a variety of relatively low-cost analog devices and try to answer difficult questions. Often having to disappoint the patient by sending them on to another person or facility to eventually get to their answers.
The stark reality is that it is the primary care physician, with the greatest informational needs that should have most of the tools.
We're all familiar with the tricorder used in Startrek where Bones could scan a person in the field as well as the exam room, view the images and make a diagnosis.
What's silly is that by the time a patient is seen by the subspecialist the diagnoses have already been made (usually by several other physicians who have sequentially seen the patient at an ever increasing cost). By the time the patient gets to the highest technology it is used only to confirm the diagnoses and to complete the definitive treatment.
It's my opinion that if technology was available at the front lines many diseases would be diagnosed, caught and treated long before they require subspecialised therapy or treatment.
There are many devices such as a dermatoscope, tonopen, digital ophthalmoscope, otoscope, not to mention digital scales are available but outside the reach of most primary care physicians. Yet, if each exam room was equipped with these digital devices AND connected to their electronic medical records many diseases that now are missed could be diagnosed earlier, more accurately and treated at a much lower cost than they are now.
On the pure information front, I find the time cost of logging into multiple systems (our own EMR and those of nearby hospitals, reference labs not interfaced without our system, imaging centers, online reference sources such as UpToDate, ePocrates, MDConsult and a host of other tools that I wind up using in the exam room prevents me from exploiting them in the typical 10-15 minute appointment. Even though we’ve equipped the PCs in each exam room with 21” swivel monitors we find there’s a lot of visit time that could be saved if the all of the information needed at the time of the visit didn’t need to be navigated to.
When not seeing patients I usually grab all of the computers to which I have access, splay them up in front of me (including one of the units from the nearest exam room). Productivity increases dramatically. Most information resources are at my fingertips in parallel rather than serially if restricted to a single machine or reduced screen real estate. This is exactly why traders in most brokerage houses sit behind multiple displays in order to work. Time is money and faster, better (well, maybe) are made if one doesn’t have to waste time navigating to that information.
So what am I saying?
I am confident that if we would put the most technology possible into the hands of front line physicians who have to address the broadest spectrum of patient concerns we might be surprised at how much more efficient, productive and cost effective healthcare would be.
So one day I see myself practicing in a room with all of the tools at my and my patient’s fingertips. Any questions could be quickly answered, the record would not have to be populated with vague text but actual images of the pathology observed, sophisticated imaging and testing could be accomplished at the point of care before the patient left the room. The patient and I would have a very good understanding of the next steps rather than waiting for all the ordered tests to come back as the patient is sent across town for them, paying higher and higher prices the closer we get to the definitive diagnosis.
And then I wake up only to have had a wet dream. I have to return to the small, cramped, jail-cell exam room with the one computer and a variety of relatively low-cost analog devices and try to answer difficult questions. Often having to disappoint the patient by sending them on to another person or facility to eventually get to their answers.
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