hospitalist here - I think “everyone hates epic” is a major over-generalization. If you have worked with one implementation of Epic, you have worked with one implementation of Epic. It probably does not meet the standards of popular modern software, but it is complicated. If it is implemented as a replacement for paper charts, it can be terrible. If it is thoughtfully customized to support common and important workflows and support high quality care, it can be a life and efficiency saver.
As I'm in my 60s, I have elderly friends and relatives who have spent time in hospitals and rehab facilities. The patient needs to have an advocate who is informed of their situation and is present when the doctor makes their brief daily or weekly visit. I've seen decisions made, that contradicted the information in their "chart" such as exercise sessions for a person with a documented broken spine, treated as inviolable by the nurses and other clinical staff. Only the doctor can change the facts of the case.
What I suggest is that if you have a friend or relative visiting you, they should bring a "flip chart" -- the old fashioned 2 x 3 foot pad of paper -- and write down in huge letters the most important details of the case. Ask the doctor to help you fill it in.
Highly recommend reading Atul Gawande's "Checklist Manifesto" [0] if you are interested in the operational results of adding something like checklists to medical care.
Case in point: requiring everyone in the operating room to say their name, specialty and reason for the operation (and their part in it).
You might ask why the above is necessary?
Well:
- everyone is wearing a mask, cap and possibly glasses which makes them hard to recognize
- the patient is often draped in such a way that you can't tell who they are
- many Operating Rooms(ORs) look the same
- there are apparently COUNTLESS stories of medical personnel going into the wrong OR and not realizing until the surgery has started
Another fascinating point about checklists since the OP article mentions doctors vs nurses: checklists give nurses the power to challenge doctors. e.g. "Dr, I believe the next step on the checklist we agreed on is to do X".
If you have no checklist, the Dr can just say "No, we don't need that, I know what I'm doing. Shut up, Nurse!" (this is a real example from the book btw).
He also has an article comparing the Cheesecake Factory to health care that I also highly recommend [1]
Wow. Fascinating article. I am an engineer in a family that is otherwise purely medical (mom nurse, dad pediatrician, sister veterinarian).
Over the years I hear a lot of their pain points, and EMR's are consistently very painful for my boomer parents who are not tech savvy (my understanding is that it's not an age thing, though).
I have personal experience with pt. 8: Doctors know who's good, they just won't tell you. When I had a meniscectomy with poor results, none of the orthopedists I visited after the surgery would comment even lightly on the appropriateness of that procedure given my symptoms and MRI. This isn't different to other professions, where you generally have nothing to gain from badmouthing colleagues, but its incredibly painful that thousands of people are prevented from good care because of this meritocratic breakdown.
As a totally separate point-- this format of shadowing notes in incredibly compelling! I've been shadowing chemistry and biology wet-labs lately, and I wonder if making similar writeups would be interesting to others?
Nurses know, too; they just can't tell you because they are not licensed to give medical advice.
Once, in a situation when we really wanted an opinion from a nurse who wouldn't give one, we finally asked, "If it was your daughter, what would you do?" With no hesitation, she told us exactly what she would do. She just couldn't tell us what we should do.
That phrasing has proven to be useful a time or two since then...
Reading this, it's not surprising why alternative medicine remains popular. Generally, the practitioner both acts like a human and treats their patient like a human. That doesn't appear to be the case in a conventional hospital.
> Doctor competence is highly variable, as there are few incentives for improvement.
> But all hospitalists are paid under the same schedule (based on years of experience), meaning that the high-agency hospitalist is getting paid the same as their counterparts. Greater intrinsic motivation and competence are not explicitly rewarded.
I find it very hard to believe that it’s possible to measure “greater intrinsic motivation and competence” objectively here (and for GPs as well, basically any profession with high variety in the Stafford Beer sense), so explicitly rewarding that seems fraught with Goodhart-style problems.
Thanks, but that doesn't really answer my question. It demonstrates that it is a thing in America, but for it to be an exclusively American thing I would really need some confirmation that it is not widely used in other places. Cheers for whoever downvoted, would love to understand why asking a question gets a downvote?
Similarly, my sister-in-law is a hospitalist, so I've come to consider it a commonly used and widely known term, but now that I think about it I don't believe I've ever heard anyone use the word except in conversations with my sister-in-law and brother.
What I suggest is that if you have a friend or relative visiting you, they should bring a "flip chart" -- the old fashioned 2 x 3 foot pad of paper -- and write down in huge letters the most important details of the case. Ask the doctor to help you fill it in.
Case in point: requiring everyone in the operating room to say their name, specialty and reason for the operation (and their part in it).
You might ask why the above is necessary?
Well:
- everyone is wearing a mask, cap and possibly glasses which makes them hard to recognize
- the patient is often draped in such a way that you can't tell who they are
- many Operating Rooms(ORs) look the same
- there are apparently COUNTLESS stories of medical personnel going into the wrong OR and not realizing until the surgery has started
Another fascinating point about checklists since the OP article mentions doctors vs nurses: checklists give nurses the power to challenge doctors. e.g. "Dr, I believe the next step on the checklist we agreed on is to do X".
If you have no checklist, the Dr can just say "No, we don't need that, I know what I'm doing. Shut up, Nurse!" (this is a real example from the book btw).
He also has an article comparing the Cheesecake Factory to health care that I also highly recommend [1]
0 - https://amzn.to/3KyLK1x
1 - https://www.newyorker.com/magazine/2012/08/13/big-med
Over the years I hear a lot of their pain points, and EMR's are consistently very painful for my boomer parents who are not tech savvy (my understanding is that it's not an age thing, though).
I have personal experience with pt. 8: Doctors know who's good, they just won't tell you. When I had a meniscectomy with poor results, none of the orthopedists I visited after the surgery would comment even lightly on the appropriateness of that procedure given my symptoms and MRI. This isn't different to other professions, where you generally have nothing to gain from badmouthing colleagues, but its incredibly painful that thousands of people are prevented from good care because of this meritocratic breakdown.
As a totally separate point-- this format of shadowing notes in incredibly compelling! I've been shadowing chemistry and biology wet-labs lately, and I wonder if making similar writeups would be interesting to others?
Once, in a situation when we really wanted an opinion from a nurse who wouldn't give one, we finally asked, "If it was your daughter, what would you do?" With no hesitation, she told us exactly what she would do. She just couldn't tell us what we should do.
That phrasing has proven to be useful a time or two since then...
> But all hospitalists are paid under the same schedule (based on years of experience), meaning that the high-agency hospitalist is getting paid the same as their counterparts. Greater intrinsic motivation and competence are not explicitly rewarded.
I find it very hard to believe that it’s possible to measure “greater intrinsic motivation and competence” objectively here (and for GPs as well, basically any profession with high variety in the Stafford Beer sense), so explicitly rewarding that seems fraught with Goodhart-style problems.
https://www.hospitalmedicine.org/about-shm/what-is-a-hospita...