A well-done Audible recorded book and, probably, a good book in print/Kindle form: Cook County ICU. A few things that I learned from it…
The modern insurance/Medicare/Medicaid system requires that hospitals seeking to get revenue give each patient a concrete diagnosis prior to hospital admission. This results in inferior care because the doctors treating the patient become anchored to the initial diagnosis, which is often merely a guess.
Never agree to be a consultant to Hollywood. The author accepts a request to work as a medical advisor for The Fugitive (Harrison Ford plays a vascular surgeon) and puts in a huge number of hours on the project. Money is never discussed. He eventually gets a check for $1,100 (in pre-Biden money) for his work on a film that earned almost $370 million (pre-Biden dollars) at the box office.
From the author’s point of view, there were huge advances in medical technology over his 40 years of practice. The electronic medical record wasn’t one of them, however. It has delivered few benefits, in his view. The practice of having a physician look at a screen and type at a keyboard while interviewing a patient is particularly harmful.
Being sued for divorce is a common way to transition out of the middle class and into the free clinic where the author worked after retiring from the big hospital.
HIPAA is ridiculous, making it easy for insurers, hackers, and the government to get your medical information, but not you or your family members.
Cold is far more deadly to humans than heat. Although we are assured by Science that a warmer climate will result in near-term extinction of humanity, in Chicago it is the cold winter that kills people, not the hot summer.
Not every anecdote is equally rewarding, of course, but there are a lot of great ones!
Related:
- The Son Also Rises: economics history with everyday applications (the author was an accomplished physician whose father was an accomplished physician)
- Medical School 2020
The Goodreads reviews are not too impressive for this and they’re usually pretty generous.
A small thing – I thought that nowadays medical scribes are used so that the doctor can have a more natural interaction with the patient.
Mitch: I see docs at the Cleveland Clinic here in South Florida and they’re often looking/typing at a screen while interviewing me. They don’t have a budget to put an additional person in the room, apparently. Some of the concierge docs here in Palm Beach County use electronic medical records and always have a PA, NP, or nurse in the room to sit at the screen and take all of the notes.
Mitch: The book is a collection of anecdotes, some of which are more interesting than others. Especially if consumed in print/Kindle, the reader who isn’t interested in Hollywood, for example, could just skip the Harrison Ford content.
phil: OK. The lower cost alternative is to outsource the scribing to remote workers. My daughter did this for a while.
Mitch: If the Cleveland Clinic were to record everything said in the room and send out the audio file for transcription, wouldn’t the doctor then have a second task a few days later of reviewing the transcription and deciding what parts to include in Epic and verifying the accuracy?
phil: They did do random audits, but I don’t know how they address the issue you suggest. Maybe there is still a net benefit to having the patient feel “heard” and still having EMRs. Or maybe it’s a rounding error in the health care system.
The doctor probably did not negotiate his fee for the film because he was expecting Medicare or insurance to pay him.
> Cold is far more deadly to humans than heat. Although we are assured by Science that a warmer climate will result in near-term extinction of humanity, in Chicago it is the cold winter that kills people, not the hot summer.
Sure, *in Chicago*; meanwhile some quick googling indicates cold-related deaths are about 1/10 of heat-related deaths in Arizona in the 2020s, let alone in the 2050s.
That’s because it is never cold in Arizona! Worldwide way more people die from cold than heat.
EMR’s were another bad-idea government requirement. Data entry trumps patient interaction.
This year they (CMS) changed the documentation rules to emphasize a medical decision-making narrative. At first I thought it was another of the usual excuses to pay less, but now I think it’s to give LLM’s something easier to chew on so they can learn medicine.