Imagine that you are a cardiologist. You work at a large hospital in Oklahoma City. You are about to perform a heart catheterization on a patient. The “system goes down.” What ? You mean that a computer system might fail? You have no medical records because they are digitalized on “the system.” You have no idea what this patient’s history is or what it is they need or what you had planned to do for them. You ask the patient,”..do you mind telling me what it is that I see you for?”
This would be crazy if it weren’t true. This happened here in Oklahoma City. There wasn’t a paper chart or handwritten notes to rely on.
Imagine that you are a surgeon that always prescribes the same thing for patients just prior to surgery. Eye drops. Antibiotics. Ear drops. Nose drops. Everytime. The system doesn’t post these “standing” orders for one reason or another. In a world full of human beings the nurse would think, “Dr. X always gives his patients Afrin nose spray and antibiotics prior to their surgery. I know that’s what he wants even though this order didn’t come through.” He or she would then give the appropriate meds. In a world full of robots, however, that have been told not to think, but just do what is on the order list, this medical error would result in the patient not getting what they needed. This would be crazy if it weren’t true and happening every day at a large hospital here in town.
Imagine that you are a patient and you have gone to see your doctor whose practice was destroyed by a hospital administrator and is now an employee of the hospital and his computer system is “integrated” with that of his employer. Your (well…formerly your) doctor types your responses to questions that the computer is prompting him to ask you with his back to you the entire time. One of your answers is not on the list of acceptable preconceived responses listed by the computer. The doctor says,”your response is not on here. I need for you to say that it is one of the three things that are listed here.” This, too, would be crazy if it weren’t true.
Imagine that your child has had their tonsils removed and starts bleeding the next day (a legitimate medical emergency). You go to the emergency room where with no code for “acute post-tonsillectomy bleeding” your child’s computer label is “wound drainage.” This label fails to communicate the urgency of the situation and the staff at the emergency room wait far too long to address this. This, also, would be crazy if it weren’t true.
Imagine that five years from now your physician has lost his license to practice medicine or has been blacklisted by your insurance company because the treatments he/she recommended (while perfectly suited for you) didn’t match up with the “best practices” paradigm designed by computer testing models. If a recommended treatment doesn’t match up with the pattern of data in the electronic patient survey (most of us still call this the patient’s chart) that physician is in trouble. This type of control is well on its way thanks to our wonderful public servants in D.C.
Are you ready for it?
G. Keith Smith, M.D.
