You rock May 21, 2010 7:40 AM   Subscribe

Update on this post about child with mystery fever.

There weren't a lot of comments in the thread, but I hope this still merits a MeTalk post. You guys saved this mother and child a lot of pain and worry, and I'm very grateful.
posted by Evangeline to MetaFilter-Related at 7:40 AM (47 comments total) 1 user marked this as a favorite

Yay, very glad to hear it.
posted by ThePinkSuperhero at 7:50 AM on May 21, 2010


Why not thank in-thread? Your post is from only two days ago.
posted by Tobu at 8:03 AM on May 21, 2010 [1 favorite]


I did thank in-thread. Just wanted to make sure they saw it, since not everyone checks "recent activity" as religiously as I do.

But the mods can feel free too close this up if they think it's not necessary.
posted by Evangeline at 8:06 AM on May 21, 2010


Its just a day full of happy updates and lots of shmoopy.
posted by anastasiav at 8:12 AM on May 21, 2010 [2 favorites]


I wish I could find that old metatalk post that basically said no health related AskMes should be allowed. Because this post would laugh at that post.
posted by inigo2 at 8:20 AM on May 21, 2010 [1 favorite]


I think the extra thanks is definitely in order.

Booksmith: "As an active person, Helene Jorgensen decided to enjoy a hike in the mountains one afternoon while attending a conference in Montana. Warned by friends to beware of bears, Jorgensen was attacked by a creature much more menacing -- the Rocky Mountain wood tick. Sick and Tired is the story of Jorgensen’s subsequent illness and her descent into the quagmire that is the American health care system.

Returning home from her trip, Jorgensen is quickly debilitated by a mysterious illness and sets out to find a diagnosis and cure. Along the way, she is seen by countless doctors, none of whom seems to be able to diagnose her accurately. She undergoes two surgeries, is forced to quit her job as a labor economist, and is saddled with countless bills and denied payment for claims. Jorgensen quickly learns that the health care system does not work; finally diagnosed with Lyme disease, she struggles for years to receive proper medical treatment. "
posted by cashman at 8:20 AM on May 21, 2010


And it looks like "folks from the Internet" picked something that what would be more than one doctor failed to test for. That would be a point against the gatekeeping stuff.
posted by adipocere at 8:22 AM on May 21, 2010 [2 favorites]


Holy shit - it turns out you SHOULD be asking random people on the internet about medical questions!

Glad the little fella is going to be ok! Go metafilter!

This has convinced me that MetaFilter should start an award system, where mods can give out awards that you can put up on your profile. In this case, anastasiav should get an award for saving a little boy! (other people helped, but anastasiav got there first FTW)

Maybe the "Doctor of Internet Medicine" award, or maybe the "MetaDoc" award for outstanding medical advice.
posted by Salvor Hardin at 8:25 AM on May 21, 2010


I'm very surprised the doctors didn't test for this, since we live in New York and I think the particular tick that carries the disease is indigenous to the northeast U.S.

Her next move is getting a new doctor.
posted by Evangeline at 8:29 AM on May 21, 2010


Evangeline, it's the deer tick, and it's all over the NE US. It should have been thought of earlier, yes. But good thing it's been caught now!

And as an amusing story, when a friend of mine was in elementary or middle school, his family went on vacation to Arizona. While there, said friend became very ill. The doctors had no idea what it was. They could offer no explanation. And then they suspected the bubonic plague.

Turns out he had lyme. I don't recall if he was finally diagnosed in AZ or when he returned home to CT. But either way, lyme is nigh upon unheard of in the Southwest, though the plague still lives on there.
posted by zizzle at 8:37 AM on May 21, 2010


Wow, Metafilter's really kicking ass and taking names this week.
posted by phunniemee at 8:39 AM on May 21, 2010 [3 favorites]


Wow, Metafilter's really kicking ass and taking names this week.

Now, if we could only once and for all determine whether or not Jesus is Lord.
posted by philip-random at 9:00 AM on May 21, 2010 [1 favorite]


Evangeline- posted a link to the columbia tick / lyme research center in NYC, where I was finally properly treated for my long term lyme infection. Your friend's sons story sounds very familiar to mine, and if I had gone to columbia when they first diagnosed me with lyme, instead of 4 years later, I probably would have had a much happier time in those years in between.
posted by mrzarquon at 9:13 AM on May 21, 2010 [1 favorite]


Lyme disease is a sneaky bugger. Last summer, my dad was sick as a dog for weeks before they figured out it was Lyme, and he's a doctor who lives in the Mid-Atlantic. The disease itself is relatively common, but it presents itself in so many different ways and times that it's usually the last thing people think of, even doctors in the Northeast.
posted by valkyryn at 9:25 AM on May 21, 2010


Yay! I'm so glad it turned out okay.
posted by anniecat at 9:49 AM on May 21, 2010


Now, if we could only once and for all determine whether or not Jesus is Lord.

I can answer that. He's not.
posted by anniecat at 9:50 AM on May 21, 2010


Though I could easily change my response if money were to be offered my way=)
posted by anniecat at 9:50 AM on May 21, 2010


Naive question: why didn't the doctor think of this?

When I go to the doctor, he asks and tests for symptoms, and then he SEARCHES HIS MEMORY and makes a prognosis. I have never once heard a doctor say, "let me google that" (or "let me type your symptoms into blah-blah-blah medical database.")

I am not even remotely suggesting that doctors should be replaced by databases, but I don't understand why more don't use them as tools. To me, in this day and age, that seems un-ethical.

We all know that memory is faulty. When I tell a doctor my symptoms, I have a reasonably expectation that he'll see -- on a screen or in his brain -- a list of ALL pathologies that might produce them. I don't EVER want to hear a doctor say, "Huh. I never thought of that," when it's something that could be thought of easily by googling symptoms.

What am I missing? Is it silly to expect doctors to do this? Is it silly for me to get upset that random people on the internet diagnosed this but the child's doctor didn't?
posted by grumblebee at 10:22 AM on May 21, 2010 [4 favorites]


You will be disappointed should you have those expectations. I wouldn't say that your expectations are silly so much as they are consistent with how the medical establishment presents itself. I've gone on previously and at length, with some of my own experiences ... plural. You can blame HMOs or the passing of time or whatever, but the results are the same.

Fun game you can play at home: before you head to the doctor the next time, write down your symptoms. Get online and do a little research. Narrow down to what you think it is. Then, on a separate slip of paper, write down what you think they will prescribe. Don't tell the doctor you have done this. Nothing at surreptitiously glancing down at the piece of paper in your hand that says "hyoscyamine" just as the words come out of his mouth.

My success rate at figuring out what is wrong with my car is a little lower, oddly. And my mechanic will fix, gratis, anything he screws up.
posted by adipocere at 10:48 AM on May 21, 2010 [3 favorites]


> What am I missing? Is it silly to expect doctors to do this? Is it silly for me to get upset that random people on the internet diagnosed this but the child's doctor didn't?

Lyme disease can express itself in a variety of different symptoms, most doctors are told to look for the bullseye rash, which does not always appear in cases of tick bites. Also there is the assumption that you have to be hiking in backcountry to get it, when in fact the primary carrier of deer ticks is not deer in most regions, but white tailed field mouse which could easily live in your pachysandra (which could then get on your cat and transfer to you).

Unfortunately there is not a really clear, definitively proven way to determine if someone has Borrelia burgdorferi (the agent that causes lyme disease). I've had western blots come back negative from one lab and positive from another. There is also an even larger issue of contention as the health insurance companies really don't like paying for the longer term treatments, so there is a messed up situation where the illness doesn't exist in larger forms in the eyes of insurance companies since otherwise it would cost them money. The group writing the guidelines for treatment of lyme in CT were found to have conflicts of interest in that they had financial ties to insurance companies among other things.

So on one side you have a legitimate disease, that can manifest a score of weird and strange symptoms, is itself difficult to treat depending on how soon it is identified (since the longer it goes unnoticed, the bigger the infection spreads), and on the other side, you have the medical communities access to the right information about it possibly controlled by financial interests, instead of ones regarding human health. The resulting vacuum in care has lead to some 'specialists' who crop up who think that a combination of antibiotics and homeopathy (i'm serious, magic water) are surefire treatments for the illness. Since people who suffer from any one of the myriad symptoms are unable to get the treatment (or trust the treatment) of a physician, there has become this crazy fringe mixture of fake and fiction around the illness.

The amazing thing is? Connecticut is one of the hardest places to get good treatment for it, even though it was found there. But go to a doctor in maryland and say you've started having a fever, flu like symptoms, after going on a hike in back country CT? They may throw you on doxy faster than you can say bullseye and get your blood rushed to a lab asap.
posted by mrzarquon at 11:08 AM on May 21, 2010 [8 favorites]


Oh man, I've contracted lyme twice in my life (I only know that the second one was a reinfection, not a flare-up, because I had a bulls-eye rash, which I didn't even have the first time). The first time, I was 12 and just had a terrible headache for three weeks straight that only sleeping would kill. Guess all that riding around on my bike out in the woods that summer came back to bite me in the ass. Both times, I was fine with antibiotics.

Best of luck to the mom and kid.
posted by PhoBWanKenobi at 12:07 PM on May 21, 2010


grumblebee,

You know what you call the guy who was bottom of his class at med school?

Doctor.
posted by atrazine at 1:10 PM on May 21, 2010


> I have never once heard a doctor say, "let me google that"

In the UK, almost every time I've been to the dr for something not immediately obvious my GP has Googled it - I've heard the same from others too. Could this be something varying by country?
posted by paduasoy at 2:14 PM on May 21, 2010


@grumblebee

I've seen a doctor use a diagnosis assistant (in France, for a knee issue). It probably wasn't necessary, but it is reassuring for the reasons you explain. As I remember, the first application of expert systems was medical diagnosis, and they work well for this.
posted by Tobu at 2:21 PM on May 21, 2010


Consider the possibility that this is oh, the millionth time someone has thrown out lyme disease as a possibility on AskMe. This dumb doctor just used his thumbs to type in lyme disease on UpToDate. It took me 45 minutes to figure out how to use the keyboard but the screen said the following before stealing my soul:

"The frequency of fever and nonspecific symptoms as a presentation of Lyme disease is not known. However, information from clinical trials of Lyme vaccine, in which subjects had routine serology performed by a reference laboratory, suggests that it is uncommon (<0>
"We recommend that children with only nonspecific symptoms not be routinely tested for Lyme disease. It is virtually impossible to confirm a diagnosis of Lyme disease in such patients. Nonspecific symptoms of a viral-like illness from causes other than Lyme disease are common, particularly in children. Given the low prevalence of Lyme disease in the population of patients presenting with isolated nonspecific symptoms, the positive predictive value of serologic test results is low [6,41]. Most of the positive results will be falsely positive."
posted by drpynchon at 2:25 PM on May 21, 2010 [2 favorites]


See how stoopid I be. I can't even get html right. Should read:

"The frequency of fever and nonspecific symptoms as a presentation of Lyme disease is not known. However, information from clinical trials of Lyme vaccine, in which subjects had routine serology performed by a reference laboratory, suggests that it is uncommon (less than 0.3 percent of patients in the trial) [40]." etc.
posted by drpynchon at 2:28 PM on May 21, 2010


Pretty sure nobody is saying all doctors are "stoopid". And maybe Lyme disease is not common. But in this case, they've been running tests for months without any luck, and... what is the saying? "When you eliminate the impossible, whatever remains--however improbable--must be the truth." So I am still a little surprised that after all this time and all these tests, it never occurred to anyone to test for Lyme disease.
posted by Evangeline at 5:09 PM on May 21, 2010


grumblebee , most general docs in Sweden have access to a medical database, and all have a big hefty database (used to be a massive book) for medicines and their side effects. I still hear about half the time mom goes to pick up medications how the pharmacists will disallow that type of medication as it will make other illnesses/issues she has worse, and sometimes the mix of meds can be downright dangerous. Better tools don't make better docs unfortunately.
posted by dabitch at 5:10 PM on May 21, 2010


Hmmm, that came out wrong. Every doc, from you ear-nose-and-throat guy to your obstetrician has access to your entire medical history, as well as a large helpful medical database. Still, you'll have some doctors staring solely at their speciality, and forgetting that the body is connected, thus making mistakes like prescribing medications that aggravate the gallbladder, on a patient who has gallstones.
posted by dabitch at 5:17 PM on May 21, 2010


I don't think better tools make better docs. But I don't understand why more doctors don't use tools that, to me, seem obvious and easy. I'm not maligning doctors. I'm trying to understand.

I'm not a doctor, but I am a professional in other fields. And I don't trust my memory. When I'm writing a program and my boss comes to me and says, "Is there a commend in your programming language that does X?" I'll say, "I'm don't think so, but I'll check and make sure. Give me a minute."

I do this, because I know it's a big language. I'm an expert at it, but that doesn't mean I remember everything. It means I know a lot of it and I know how to look up what I don't know. Honestly, I've never worked in any field where I didn't constantly use reference materials, so I don't understand people who don't.

When you watch "House" (which I know is fiction), they all sit around in a room, call out symptoms and make guesses at what's wrong. Okay, that's TV and it's not dramatically interesting to see someone say, "Let me type the symptoms into a database," but I've never heard one of my doctors even mention looking anything up. Aren't they scared that without memory jogs, they MIGHT forget or overlook something?
posted by grumblebee at 5:22 PM on May 21, 2010


Every doc, from you ear-nose-and-throat guy to your obstetrician has access to your entire medical history, as well as a large helpful medical database. Still, you'll have some doctors staring solely at their specialty, and forgetting that the body is connected, thus making mistakes like prescribing medications that aggravate the gallbladder, on a patient who has gallstones.

What frustrates me about that is it's preventable. It's something machines are really good at and humans are really bad at. Why isn't my history in the doctor's computer network, and why, when he enters in the medicine he's prescribing me (which, of course, he doesn't), doesn't an alert message pop up and say, "Medication may harm this patient"?

People are terrible and remembering and mentally juggling all these little facts, so I don't blame my doctor for making mistakes. I blame him for not correcting those mistakes in an obvious way.
posted by grumblebee at 5:25 PM on May 21, 2010


So I am still a little surprised that after all this time and all these tests, it never occurred to anyone to test for Lyme disease.

The point is that the blood test for Lyme disease is crappy, and its positivity by no means guarantees that the person actually has the disease. As noted, in the case of isolated fevers as the only symptom, the pre-test probability that the person actually has Lyme disease is so low that a positive test may be more likely to be a false positive than a true positive. In other words the test may be worse than a coin flip. Consequently, testing for Lyme disease may not really belong on the radar at least at first. As other possibilities (the list is long) are considered and ruled out, the pre-test probability of the person actually having Lyme may begin to rise, altering the utility of performing the test itself. Blood tests vary in quality, and in the case of Lyme disease, a blood test alone simply can not diagnose the disease.
posted by drpynchon at 7:08 PM on May 21, 2010 [1 favorite]


I understand what you're saying, drpynchon, but in her case, when she suggested the test, her doctor actually slapped his forehead and said, "I can't believe I didn't think of that!" Not exactly confidence-inspiring.

But maybe he was just being a sarcastic jerk.
posted by Evangeline at 7:19 PM on May 21, 2010 [1 favorite]


I understand what you're saying, drpynchon, but in her case, when she suggested the test, her doctor actually slapped his forehead and said, "I can't believe I didn't think of that!" Not exactly confidence-inspiring.

But maybe he was just being a sarcastic jerk.


Yeah that's just plain stupid. Can't make excuses for that.
posted by drpynchon at 7:28 PM on May 21, 2010


For me, this would be a hard situation to navigate. On the one hand, I want to go into the doctor's office prepared, and the internet can be a valuable tool. On the other hand, I know it has to be annoying for a doctor when a layperson shows up with a printed article from Wikipedia and insists that they must be tested for this or that improbable condition.
posted by Evangeline at 7:49 PM on May 21, 2010


I want to see an episode of Dr. House vs. AskMetaFilter.
posted by Jacqueline at 8:54 PM on May 21, 2010 [1 favorite]


I want to see an episode of Dr. House vs. AskMetaFilter.

We'd know damn well right away it wasn't lupus.
posted by maqsarian at 10:51 PM on May 21, 2010


Pretty sure nobody is saying all doctors are "stoopid".

That's, uhh, pretty much what adipocre is saying.
posted by rodgerd at 1:25 AM on May 22, 2010


I've had western blots come back negative from one lab and positive from another.

This isn't really that surprising.

Once upon a time I was trying to probe a western of a monoclonal antibody for impurities and was having a devil of a time. I was using biotinylated anti-impurity antibodies as my primary and streptavidin dye conjugate as my secondary. As a negative control I ran some of my unbiotinylated primary antibody on the gel. Guess what lit up like Christmas time.

With the right antibodies and samples I've found a few nanograms of protein with a western. I've also had westerns that were really great total protein stains. It's like we're throwing the blood of a sacrificial goat on our problem rather than using a really high tech instrument.
posted by Kid Charlemagne at 1:25 AM on May 22, 2010 [1 favorite]


Now, if we could only once and for all determine whether or not Jesus is Lord.


I think many of us have determined the answer, what we have failed to do is agree.
posted by Disinter at 3:25 AM on May 22, 2010 [2 favorites]


That's, uhh, pretty much what adipocre is saying.

That's not how interepreted it. He/she sounds like someone who's been disillusioned after some bad experiences, but you have to put a pretty negative spin on it to come up with "all doctors are stupid".

And geez - guys can we retire the "uhh"'s and the "umm"s from our posts? It's so dismissive and condescending.
posted by Evangeline at 7:13 AM on May 22, 2010


Lyme disease is a righteous bitch of a disease, well known for destroying lives once its established itself. I had a teacher when I was in art school who had a permanent substitute running the class because she was in the throes of full Lyme disease and unable to get out of bed most days. She suffered extreme fatigue and chronic pain and was completely unable to function. For years.

My understanding is that one reason Lyme disease is difficult to diagnose is that it manifests practically every symptom known to medicine - from fever to depression and back again - and does so in a wholly inconsistent way. One person may never get a fever, another may not get the fatigue. Amongst those manifesting Lyme disease, you might or might not see a fever.

Additionally, fevers are a hella common symptom. Thus the .3% figure above...
posted by kaibutsu at 7:18 AM on May 22, 2010


rogerd: That's, uhh, pretty much what adipocre is saying.

It's not impossible to interpret adipocere's two comments that way, but you're doing a fair bit of reading between the lines to do so.

Evangeline: On the one hand, I want to go into the doctor's office prepared, and the internet can be a valuable tool. On the other hand, I know it has to be annoying for a doctor when a layperson shows up with a printed article from Wikipedia and insists that they must be tested for this or that improbable condition.

My doctor recently retired and my HMO has assigned me a new one, so I've been thinking about meeting this new person and having to form a whole new doctor-patient relationship. I'm seriously considering saying to her, at some appropriate point in the visit, "So, Doctor, how can I demonstrate to you that I am an intelligent, informed layperson who tries to educate myself about my health and wellbeing and make reasonable health care choices based on both the best information available to me and my own experience, not an oversensitive hypochondriac who comes in clutching reams of printouts from questionable websites about rare and unlikely conditions?" Maybe she'll consider it a good sign that I generally print articles by and cite references to Doctor So-and-So of the Such-and-Such Research Institute of Wherever University, not Wikipedia. I hope so.

Evangeline: And geez - guys can we retire the "uhh"'s and the "umm"s from our posts? It's so dismissive and condescending.

Hear, hear.
posted by Lexica at 10:24 AM on May 22, 2010


Does anyone remember the days when doctors would actually pursue throat cultures and do lab tests when dealing with some sort of pathogen? I have noticed in the past 20 years that most doctors stick rigidly to "sounds like" diagnoses (YES, not consulting any literature) and then prescribe some random medications. This is not some isolated instance... I see it all the time and I find it really unsettling. I suppose the situation is better with specialists, but it's the GPs that I find it hard to have respect for as professional practitioners.
posted by crapmatic at 10:51 AM on May 22, 2010


"So, Doctor, how can I demonstrate to you that I am an intelligent, informed layperson who tries to educate myself about my health and wellbeing and make reasonable health care choices based on both the best information available to me and my own experience, not an oversensitive hypochondriac who comes in clutching reams of printouts from questionable websites about rare and unlikely conditions?"

Why does this awkward conversation need to happen? Are doctors more arrogant than most people? I'm sure they're not, so I'm not rhetorically implying that they are. I'm just mystified by my FEELING that (a) they are and (b) they don't like looking stuff up. I want someone to come in here and explain to me a way to see things differently.

When I direct plays, an actor doesn't have to come in and say, "Um. I hope you don't mind, but I read the script and formed some ideas about it, and I know this may seem impertinent, but I read some interviews with the playwright and looked up words I didn't know in the dictionary... I hope you understand that I'm not trying to usurp your authority. I'm just trying to be an informed actor." In fact, what pisses me off is actors who don't do any work on their own.

When I work as a programmer, I wouldn't get pissed off if a client said, "I've done some research on Flash vs HTML5, and it looks to me like..." I'd be excited.

And when I teach, I'm not offended if a student has read a bunch of books about the subject I'm teaching. I am thrilled to get to talk to someone who shares an interest with me.

I don't think I'm especially confident or easy-going. Lot's of people are fine if, as experts, they get to discuss things with informed lay-people. Of course, no expert wants a lay person to say, "I don't give a shit about your so-called expertise. I read on the Internet that you're wrong!" But most people don't do that. If they do, then they are just assholes, and assholes are going to be offensive in some way, anyway.

So why is there a perception that we have to walk on eggshells if we do research before seeing a doctor? Is there something about the sort of person that chooses to become a doctor that would lead him to being arrogant? If not, then why does this perception exist? Do doctors need a PR firm to help them have a better public image?

(My doctor is not like this. When I visit him, I openly discuss stuff I've read and researched, and he says things like, "I can see you've put a lot of thought into this.")
posted by grumblebee at 11:34 AM on May 22, 2010


Nah, rogerd, let me break it down. What I'm getting at is that 1) doctors (being human) are not perfect in either diagnosis or action. 2) Doctors (like many other professionals) engage in rent-seeking and gate-keeping behavior. 3) Doctors encourage a perception of near infallibility and discourage advice-seeking elsewhere, which is also partially backed up by society as a whole. These combined lead to:

A) Everyone throwing around disclaimers of varying length when suggesting so much as an aspirin, on AskMe or on any other forum. A minor irritant at best, more of a symbolic mark that one has acquiesced.

B) Medical professionals demanding that AskMe cease with the health-related questions, or at least tweak it such that only medical professionals might be able to answer, since there's a risk of people giving bad advice and then body parts begin flying everywhere.

C) A lot of sick people giving up treatment in favor of symptom management, because, after all, if the medical establishment has failed to help them, nobody can help them.

If medicine is in fact science (and here's hoping it is), that means that the people who practice medicine are not priests. They are not anointed or otherwise have some holy power conferred upon them which enables them to find solutions that others, lacking this power, cannot. That in turn implies that, like other sciences, success in figuring out a problem does not depend upon the person themselves but upon their ability to research and reason. Experiments carried out have their efficacy dependent on the experimental design, not upon the hands involved.

It is not that "doctors are stoopid" so much as imperfect, which in and of itself is hardly a problem (who is perfect, after all?), but when backed up by some kind of collective ego, leads to some fairly crappy results, like sick children who undergo batteries of medical tests without any solid result, while a bunch of folks from the Intarwebs (who, according to the medical establishment, ought not to so much as open their mouths) pick out the problem.

The results matter. Sick, undiagnosed kids are not a Good Outcome. In fact, that's pretty much the exact opposite outcome from what the medical profession is supposed to do. My suggestion is not to eschew medicine or its associated professional but rather to leave a little room for doubt, doubt being diametrically opposed to "just listen to what the nice person in the white coat says unconditionally and it will all work out." Doubt is a fantastic thing and is fundamental to the scientific method itself.

In practice that means recognizing that not all medical knowledge resides within the skulls of all medical professionals and that not all medical professionals have full and instantaneous access to all medical knowledge right behind their eyes. (How could it be true? If it isn't, why act that way?) To that end, AskMe. Google. Expert systems like MYCIN, back in the day. Those asking you to turn away from these things are interested in your faith and compliance. And we know how well that turns out when it comes to determining error rates. Only here, error rates don't look like a couple of mols too few of whatever it is you're cooking up. Errors here come in years lost, leg braces, and coffins.

If you don't have great success with a couple of doctors, it behooves you to think for yourself as well. Mindfully, not like some panicked parent galloping away from vaccines. That is my thought. Go into it with your eyes open and your homework double-checked. The "bodies are cars" analogy only goes so far. You only get the one. No trade-ins. And they're devilishly hard to fix up once something major goes wrong. When this one breaks, that's usually the end of it, unless you're within shouting distance of a good garage. The stakes are high and we have little room for do-overs.

I like to think that's a little more nuanced than "doctors are stoopid."
posted by adipocere at 3:00 PM on May 22, 2010 [3 favorites]


Why isn't my history in the doctor's computer network, and why, when he enters in the medicine he's prescribing me (which, of course, he doesn't), doesn't an alert message pop up and say, "Medication may harm this patient"?

What you're describing are, in a nutshell, function sets of clinical information software called computerized physician order entry and medical logic modules. Software with this functionality exists, and many providers do have it in place or are rolling it out right now, but the problem with it is that it's hellaciously complicated and expensive to implement well. If you're a programmer, think of the worst horror stories you've ever heard about a botched Oracle or SAP implementation - but at least when an ERP project goes off the rails, it usually doesn't kill anyone.

Then you have the question of what happens when your primary care doctor is keeping your records in Epic software, your pharmacist in McKesson, and the hospital you've been admitted to uses Cerner. Or what happens when every time the doctor tries to order anything, a "may harm the patient" message pops, so he starts ignoring them all or stops using the software altogether.

I don't want to sounds too down on software solutions to this kind of problem, because they can certainly be very useful when they work well - it's just that it's a huge resource commitment to do right.
posted by strangely stunted trees at 3:49 PM on May 22, 2010


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