Click on the links below to read Dr. Diamond's complete postings on HIStalk Practice.
6/23/10
Random Thoughts on e-Prescribing
A few years ago, I admitted a 35-year-old man to the hospital with severe dehydration and electrolyte disturbance due uncontrolled diarrhea. The poor guy started out with fairly mild symptoms. After using his neighbor’s bathroom, he looked in the medicine cabinet and saw a drug labeled colchicine. The instructions read “Take every 1 hour– gout relief or diarrhea”
For those of you unfamiliar with this old but effective treatment, you literally take it every hour until painful gout resolves, or stop taking it when you get the side effects of diarrhea. I will not comment on this gentleman’s intelligence or judgment, but somehow he misinterpreted the instructions as a treatment FOR diarrhea. Worse than that, as his symptoms got worse, he diligently followed the instructions and continued taking more, and more, and more… every one hour for the next 24 hours....
2/16/10
HIMSS: A Physicians Perspective
I am very much looking forward to this year’s Healthcare Information and Management Systems Society (HIMSS) annual lovefest. Other than geeky informatics-loving physicians, this conference is often overlooked by most practicing physicians. It is seen as a vendors’ forum with little relevance to real-life medicine. Having attended HIMSS for many years, I can honestly say that they are very mistaken, and I would urge my colleagues to reconsider....
1/6/10
On Meaningful Use
“The word ‘meaningful’ when used today is nearly always meaningless.” -Paul Johnson
Seems like everyone today is searching for a meaningful experience. Everything from bowel movements to watching a television series needs to be “meaningful”. It should therefore come as no surprise that the meaningful adoption of HIT should also be debated so passionately"...
11/26/09
Thanksgiving Edition
"When it comes to life the critical thing is whether you take things for granted or take them with gratitude.”-G.K. Chesterton
Back in the day, I used to moonlight in my local Emergency Department on Thanksgiving and Christmas. It was nice to hear both patients and staff compliment me on my dedication. Some would be a bit more realistic but equally sympathetic for my willingness to “give your Christian friends a break on the holiday”...
10/28/09
Yet More Controlled Medical Terminology
It’s been over 20 years since I read Samuel Shems’s irreverent and frighteningly realistic portrayal of medical training, House of God. It was unofficial required reading back then, and my fellow residents would quote lines as frequently as my teenage sons do from Judd Apatow movies today...
9/14/09
Random Thoughts from a Traveling Physician
Maintaining a private primary care practice while being a healthcare executive for an international company is both rewarding and challenging. Travel and interaction with doctors and nurses in diverse environments is extremely valuable in gaining new perspectives on healthcare, but often requires creative processes to remain accessible to my patients back home...
7/31/09
More About Controlled Medical Vocabularies
I remain an advocate of structured data. I believe that it is the foundation for connected healthcare. As I have pointed out in previous posts, the art of medicine often rests on the nuances of communication. The patient’s chief complaint and the physician’s history of present illness can often tell a much richer story than drop-down lists and templates. We were taught in medical school to use the patient’s exact words whenever possible...
6/2/09
Controlled Medical Vocabularies
In my last post, I discussed how our current coding systems just don’t suit the needs of everyday working physicians. For some reason, it got me all nostalgic for the good old days of paper records. Nothing like curling up in front of the fireplace with an old novel. Ahh … the texture, the smell …
5/20/09
What's Wrong with ICD
I suppose only geeky doctors amuse themselves like this: my medical partner and I used our EMR messaging to send ICD-9 related insults to each other throughout the day...
4/22/09
Why We Need Natural Language Processing
Chief Complaint: “Are my testicles black?”
Operative Note: “The patient was brought to the operating suite. She was propped and raped in the usual fashion.”
Granted, these anecdotes came from colleagues using much earlier versions of voice processing software, but they show the inherent need for voice understanding...
2/25/09
I love the HIStalk entries describing "odd lawsuits". Unfortunately, these seem to be an increasing norm in the business of healthcare. Those of us who practice on the front lines often feel that we have a malpractice target painted on our backs. It always amazes me how public policy experts downplay the huge financial burden of defensive medicine...
2/11/09
You know that you’re getting old when your kids laugh at your original iPod, calling it an antique. It’s only six years old. My original EMR is a little older than that...
2/2/09
I write this on the eve of the Super Bowl. The outcome of the matchup between the Pittsburgh Steelers and Arizona Cardinals will be known to you before you’ll read this. I thought, however, that this would be the perfect time to reflect on how a physician’s work is never done...
1/24/09
Patient Perspectives on New Technology
I remember a few years ago when one of my mentors in Family Medicine told me that the use of computers during patient encounters would destroy effective communication. "Doctors will pay more attention to the screen than their patients."...
1/14/09
I love the pick-up line from The Wedding Crashers: "Some people say that we only use 15% of our brains. I say that we only use 15% of our hearts." Interacting with many of my colleagues who have adopted an EMR in their practices, it seems that most of them use only 15% of what should be the system’s capabilities...