Tuesday, May 7, 2013

On a More Orderly Approach to Medicine
In short, the Weeds argue that medicine is plagued by a culture of severe, pervasive disorder. We are not orderly in how we evaluate patients, we are not orderly in how we match their data to our existing knowledge base, and we are not orderly in how we document our clinical processes and data.
Leslie Kernisan, MD,  “Medicine in Denial,” The Health Care Blog, May 5, 2012
In a blog reprinted in The Health Care Blog,  Leslie Kernisan,  argues Lawrence Weed, MD, and his son. Lincoln, are absolutely right in  their book Medicine in Denial. The two say that overall across the health spectrum,  physicians’ personal knowledge and analytic capabilities cannot be trusted to consistently evaluate and manage patients and often bears little  relationship to existing medial knowledge.
The book,  according to  Kernisan, has this to offer.
1.       It addresses  “two huge fundamental healthcare problems”: one, reliance on physicians to evaluate, diagnose, and manage medical problems, and two, the lack of standards for documenting and organizing clinical information. 

2.       It proposes a method of using computers and technology to consistently connect patiaent data to medical knowledge.

3.      It proposes how to reorganize medical records and clinic data to provide a fundamental of organization and transparency.
4.       Puts forew5rd a vision of empowering patients to enable them to tailor their data ato their own personal data.
The problem, assert the Weeds, is that doctors are “idiosyncratic” and individualistic  in their approaches to diagnosing, treating, and managing disease.
·         “They are re idiosyncratic in their diagnostic processes, they are also idiosyncratic in how they recommend further evaluation, or in prescribing a management plan.

·         “To make matters even worse, not only are clinicians applying idiosyncratic human processes to diagnosis and management, but they then go on to document their findings and thought-processes in spotty idiosyncratic ways. This leaves the patient without a good record of his or her medical findings, and makes it difficult for subsequent clinicians – or the patient, for that matter — to reliably build upon the efforts of the initial clinician.”

There is some truth in all of this, of course, but patients too are “idiosyncratic; in what they believe to be true and how their problems ought to be approached,  Lawrence Weed,   who pioneered the “Patient-Oriented Record” more than 30 years ago, ought to be listened to, for surely there must be a more orderly approach to straighten out that most fickle of phenomenon, human nature.

Tweet:  Lawrence Weed, MD, and  son Lincoln, have produced a must-read book  “Medicine in Denial,  in which they recommend an  approach to disease.
Leslie Kernisan, MD, MPH, has been practicing geriatrics since 2006, and is board-certified in Internal Medicine and Geriatric Medicine, She blogs at GeriTech.

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