tag:blogger.com,1999:blog-2760353953251845523.post8273654922783130594..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: The Unintended Consequences of Algorithmic, Bureaucratic MedicineJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-2760353953251845523.post-48893004158168347472011-08-22T16:02:06.142-04:002011-08-22T16:02:06.142-04:00Reading this as a non-physician, it seems the flaw...Reading this as a non-physician, it seems the flaw isn't the computerization, but the design of the system. Why are there only single check boxes that are either toggled on or off, where an omission or automatic check can lead to errors? Shouldn't every option have two check boxes? One for "Follow standard protocols", whatever they may be, and one for, "Follow physician-specific orders," with a text entry field to specify those orders? Then, if neither box is checked, it can flag that you missed something so nothing is overlooked, which seems to be the main point of automating the system, to ensure nothing is forgotten/overlooked in the orders. If there are physician-specific orders, this could also flag a follow-up call at the time they are to be carried out if anyone else has a doubt about the reasoning...that would add a double-check to the system, rather than an automatic override that adds no checks in the system, just a new source for potential unchecked errors.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-5012655687757888592011-06-09T13:01:56.401-04:002011-06-09T13:01:56.401-04:00I do see your overall point, but I see here a fail...I do see your overall point, but I see here a failure of user interface, not a failure of checklists. Of course, as an aerospace engineer, I'm rather biased towards checklists (though they're not the be-all end-all everyone thinks they are- ask a military pilot if they consult a checklist before executing a bombing run, and they'll laugh in your face). But still, if two glaring options were present at the bottom of every order: "Do exactly as instructed" or "Do as instructed under standard protocol", this problem of hidden bureaucracy could be mitigated, and perhaps even turned into part of the solution: double checking meds and the like isn't a bad thing, no?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-20162668692443396982011-06-06T10:41:36.438-04:002011-06-06T10:41:36.438-04:00Everybody's world is being affected - in the E...Everybody's world is being affected - in the ED we have the good old 4 hour to antibiotics for pneumonia rule - all based on some pretty weak data showing a small improvement in LOS without any M and M changes. The result - tons of people getting unnecessary abx in an era of ever widening antibiotic resistance.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-28363634167230901802011-06-06T09:52:03.112-04:002011-06-06T09:52:03.112-04:00Arrgh, happens so often. Scary and I have told my...Arrgh, happens so often. Scary and I have told my hospital administration and the pharmacy that if my patient has a postoperative abscess or complication that I think can lead back to the antibiotic being stopped by a NON-PHYSICIAN, or prevented being given to the patient by the same, I will be sure to tell the patient what exactly happened.<br /><br />Besides, SCIP protocols do crap to change the postoperative infection rates, even when adhered to rigidly.Kellie (General surgeon)noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-16418047220809733232011-06-05T16:00:00.030-04:002011-06-05T16:00:00.030-04:00If doctors feel powerless...what is a patient to d...If doctors feel powerless...what is a patient to do? And the changing tide will mean more cost cutting and not only do patients feel like a blur in the sea of faces....doctors shall to. It seems our entitlement mindedness is not creating better care....just hunger for more.....<br /><br />You have identified a problem...but we still feel helpless....Alice Robertsonhttps://www.blogger.com/profile/08239228141352045763noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-36376811227517890732011-06-04T16:33:51.051-04:002011-06-04T16:33:51.051-04:00BTDT SCRN.
There is often no follow up to see i...BTDT SCRN. <br /><br />There is often no follow up to see if the dictates of bureaucrats cause harm or help. Indeed these same folks cry out for "evidence based medicine" except when you ask them for the evidence upon which they base their dictate.<br /><br />That is the most confounding thing about the wonks too. Their policy is often supported at best by minimal, conflicting or extrapolated research. More often their reasoning is supported simply by story-like anecdotes or wishful thinking while they reject adverse event reports as meaningless. <br /><br />Maddening! Worse, patient endangering.<br /><br />Checklists and alerts and reminders are GREAT, and I mean that, but overriding a doctor's orders by policy enforced by a computer system? Who is liable for damages in that case, the MD?Joenoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-56360422438017080712011-06-04T12:39:13.772-04:002011-06-04T12:39:13.772-04:00You are spot on Joe.
-SCRNYou are spot on Joe.<br /><br />-SCRNAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-28562616334079852282011-06-04T09:19:59.098-04:002011-06-04T09:19:59.098-04:00What eventually happens with bureaucratic edicts i...What eventually happens with bureaucratic edicts is they become ignored and compliance is lip service. This is in fact the worst of both worlds - 1) They are absorbing the overhead and 2) They are not doing the checking, and 3) It all becomes a laughed at lie.<br /><br />Exactly the opposite of intentions is what bureaucracy delivers. In almost all cases!Joenoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-18448435256714978052011-06-04T07:50:08.423-04:002011-06-04T07:50:08.423-04:00Great post. I agree with you completely. My favori...Great post. I agree with you completely. My favorite thing about the pre-op checklist is when it's 2 am and you've just brought a patient with a knife sticking out of his abdomen to the OR. True story.<br /><br />Circulating nurse: "Let's do our time out. Have you marked the skin?"<br /><br />Me: "Yes. I wouldn't want to confuse him with any of the other patients with knives sticking out of the abdomen"Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-13086790591094907792011-06-04T06:12:56.917-04:002011-06-04T06:12:56.917-04:00Buckeye, I admit burocracy sucks, I remember when ...Buckeye, I admit burocracy sucks, I remember when they started requiring a separate "Consent for Anesthesia" which was a total waste of time, paper, and Flumazenil, cause signing the surgical consent implies that your OK with gettin some anesthesia, but if I had a dime for every patient I had to help scrawl there "X", I'd have about as much money as Lebron James/Jim Tressell/Terrell Pryor...<br /><br />Frank "SEC RULES!" DrackmanAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-62180402409575371482011-06-03T18:49:32.259-04:002011-06-03T18:49:32.259-04:00Happens every day. The other manifestation is the ...Happens every day. The other manifestation is the surgeon or anesthesiologist just giving a dose of Ancef in the OR to someone already on a therapeutic antibiotic. People just shrug their shoulders and say, "So we don't a strike against us", even though the SCIP protocols don't apply in this situation.Joshnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-59737822443752133922011-06-03T17:43:35.812-04:002011-06-03T17:43:35.812-04:00Jeff, glad to see you are blogging more regularly,...Jeff, glad to see you are blogging more regularly, must be the night shift with little buckey. BTW neat kid !! Congrats !Gary M. Levinhttps://www.blogger.com/profile/16205704913440150198noreply@blogger.com