army rants

Always an interesting sight to see somebody jump right off.

Here we have somebody post something about the SAF. Clearly this person is currently in the ARMY. He might even be somebody I know. For his sake, I hope he stays under the radar.

Our obtuse superiors are not worth crossing over matters as trivial as this.

electronic health records

Clearly a must-have. But most doctors are not keen to make the transition. NYT’s article on the issue here.  Most private practitioners locally still use antiquated white cards to store patient data. Several – including Silvercross – have made the move to wholly computerized records. Some have tried to go the middle road – storing a patient’s past history, drug allergy info, current list of medications for eg in a program whilst maintaining cards/folders for daily consults. Obviously cost is the major barrier.

Tertiary centres have already migrated to electronic health records. Here too, the adoption is by no means complete. Despite having the facility to enter and maintain electronic records of each visit, most doctors in hospitals still choose to use paper-based records for clinic encounters. Likewise for records of admissions. This has only ever led to problems:

1. The need to summarise the records each time the folder exceeds its storage capacity: inevitably a task that falls to the junior-most member of the team (usually the HO). A mind-numbing task that quickly loses meaning once you have to briefly summarise Mrs Tan Ah Kow’s admission for “giddiness and dizziness” for the 11th time. Not helped by your MO who’s unable to help out with the 12 discharge summaries and 5 case summaries because she’s nursing a skinny flat white in the doctor’s lounge (“studying for exams”).
2. Extended clinic waiting times: Most patients think that doctors have computers in their clinic rooms so that we can surf stocks / MSN-chat with our nurse-girlfriends. Not true. Computers have programs that contain patient data that we need to access. However we do need to wait for your file before seeing you in the clinic. And if your file can’t be found because a) it’s lost OR b) you force-booked your appointment and your file wasn’t retrieved to begin with, then we all need to wait. And in most tertiary hospitals, despite what you may think, the fastest means of moving one item across the hospital is the “Amah”. The speed of which depends on the state of her arthritic knees. So yes, we are probably surfing stocks / chatting but it’s only because your file can’t be found and we’re waiting for the Amah to return.

Cleveland Clinic was the first hospital to store ALL DATA – clinic visitations and admission notes – online. They had a portal that allowed patient’s records to their own medical data. Imagine the benefit of that the next time you visit your GP and he asks for a summary of what happened during your last hospitalization or clinic visit.

Please petition our local clusters NHG and Singhealth for a similar facility. It’s easier when it comes from the public. Especially if you wear white-on-white and happen to be in a GRC.

However, such institution-driven efforts are not portable and do not cater to the consumer who may travel and utilize many different providers in a short time span. Microsoft and Google have both launched programs catering to the growing industry of consumer-controlled digitized personal health records. Microsoft’s Health Vault and Google-Health are personal health record services that will

• retrieve your health records from compatible industry providers
• maintain a portable record of your health data
• allow compatible providers to access your data

Please sign up. I’m not sourcing for either company, so take your pick. Or choose both and have a duplicate record. Either way, the very act of signing up might make you think more about your own health.

Inaugural post

HELLO. This is my inaugural post to a blog that will outline my take on the problems I face in taking care of patients.

I’m a good doctor as doctors go. I listen to what my patients have to say, I actually examine them and I do base my clinical decison-making on their best interests and the best evidence available. But in my quest to provide evidence-based medicine, I’m stymied at several fronts:

1. Self-limitations: one could be as old as Methuselah and still not have read all that one needs to read in Medicine and the list of books/articles that I need to read expands near-exponentially daily.
2. Colleagues: much like one’s children, one can’t choose one’s colleagues. Some of my colleagues give antibiotics for what’s clearly the “common cold” (URTI). Others diagnose hypertension after 1 reading. Still others push generics for insured customers (who often have an insurance company imposed capitation on their bills) and non-generics for their non-insured patients.
3. Patients: if only more patients expressed the same level of interest in their health outcomes as they did in the fate of the Sat EPL matches, our jobs would be much easier. But most don’t. Some have scarcely no interest in their medical problems.
4. Lawyers: By this I don’t mean most lawyers. Just the 2 who happen to be my parents. I blame them for not having had me over international waters and thereby depriving me of obtaining some citizenship other than my current. Having said that, if you do already hate lawyers, don’t feel pressured to change.

Several of the posts on this site are designed to be self-explanatory. By that I mean that they’re written to be simple enough for me to read and understand when I’m at my most inebriated. The creation/review/re-review of these – I hope – will help me remember what I need to know. I’m not a very smart person. If I’m able to comprehend my bibulous writing, I think any slack jawed inbred mutant most people should.