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.
book, according to Kernisan, has this to offer.
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
It proposes a method of using computers and
technology to consistently connect patiaent data to medical knowledge.
It proposes how to reorganize
medical records and clinic data to provide a fundamental of organization and
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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