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PaperclipPerfector  2mo ago (text post)   25181 thread views

Culture War Roundup for the week of February 26, 2024

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To what extent should we protect patients from themselves? Two things happened this week that had me considering this again.

One, some discussion on medical reddit popped up about how to handle people (chiefly young women) requesting sterilization at a young age especially prior to having children. This has obvious implications for regret and forcing people to be locked in to insufficiently considered choices.

Two I was talking to a friend who was complaining about a side effect of laser eye surgery and she said she was not told about the possibility. In talking to her she was very clearly told about the possibility of this side effect but simply didn't get it.

This is not uncommon. Either surgeons half ass the consent process, or patients just completely fail to understand and fully grok what we tell them. Generally both.

A different example - I've had the conversation "X problem is gone because of your medication, if you stop your medication X problem will come back" "okay doc I'm here to complain about X problem, I stopped my medication" a million times. Including with smart and highly educated people. People often don't understand what is told to them and that can include things like life altering surgery.

What do we do with this? Do we let people make mistakes? Where do we draw the line?

This topic comes up very frequently in medicine but the discussion quality is generally very poor "protect them from themselves unless they want such and such political topic in which case sterilize them at their request with no counseling etc etc." I think this community may have something more interesting to say.

I especially don't know how to handle this given the tendency to strongly protect autonomy in some areas but not others.

More general CW implications include the usual trans problem, but also "protecting people from themselves instead of the more specific patients.

A rather banal way to get patients to remember medical advice is to... actually write it down. Memory is fickle and people overestimate how well they remember details.

Always shocks me that I can go for a 15 minute check up where the doctor will say 10+ things I'm supposed to remember in detail and none of it is written down.

Doctors writing down their medical advice also solves the problem of patients lying (perhaps not even consciously) about what the doctor said, which is unfortunately common.

People will not read those documents. Doctors give medical advice out loud because people pay attention to a person speaking and generally not to a stack of papers.

I find it way easier to pay attention to a piece of paper than to a doctor speaking.

This is already a thing, at least where I live. Any time I see the doctor I always leave with a handful of documents covering any medications or exercises or what have you that they are recommending. Of course I leave those papers in the car and never look at them again.

Interesting. I think this would work. Doctor just needs to make brief dot points and print it out. He can also save a copy of the notes to the patient's file (to cover his ass in the event of patient's lying).

Doctors are often lazy and or overworked though, so even though this would be a small amount of work, it would still be a not insignificant thing in the context of cramming even more activities into a 15 minute consultation.

Doctors are often lazy and or overworked though, so even though this would be a small amount of work, it would still be a not insignificant thing in the context of cramming even more activities into a 15 minute consultation.

This is solved by evaluating doctors based on their EMR, at least for outpatient visits. Number of visits must match the number of new EMRs and randomly selected and anonymized EMRs are then evaluated by unaffiliated medical workers against a checklist.

It's pretty common to give print outs like medication information sheets, or something called an "after visit summary." Frequently what happens is that it gets comically enormous and useless as various stakeholders fill it with random bullshit.

Anything more personalized/off the cuff becomes extremely difficult, especially as corporate control of medicine pushes doctors to see more patients faster. Really hard to do when your visits are 15 minutes max and that's supposed to include your charting time.

Frequently what happens is that it gets comically enormous and useless as various stakeholders fill it with random bullshit.

Could you give any examples of "erroneous"? I've certainly seen "enormous"/"useless"/"random bullshit", and burying important truths in so much filler they get ignored might have consequences as bad as falsehoods, but I just don't recall seeing any likely falsehoods. Even the random bullshit is unevidenced rather than obviously untrue, along the lines of "let's put X in the list of possible side effects, as CYA, even though our only evidence for X is that in one study the treatment group reported it almost as often as the control group"...

Not nearly as common as death by volume of paperwork, but an example of actual errors is when practice changes due to new information, and nobody updates the info sheets.

Yeah I was talking about something a bit more personalised for condition management that is tailored to the patient rather than a source sheet ripped straight off webMD. Agreed that there probably isn't time to do this in a 15 minute consult unless the doctor is young really on the ball.

I actually try to find younger GP's for this reason. Many boomer doctors just have not kept up with newer treatments, a professional bedside manner, or technology use.

That approach can be fine for medical (as opposed to surgical specialties - in those you want someone who has some years of physical practice without being too far along in age), although the caution is that medical knowledge changes quickly. I remember within a couple years of starting residency (much less being an attending) some of what I was taught was outdated and it would have been very easy to not notice.

As to your other piece a lot of surgeons (and things like Oncologists) will have ancillary staff who can help generate counseling and additional information for patients in a way that is actually helpful.

This is basically how electronic medical records already work. Good ones have things neatly templated for different sorts of encounters and voice recognition to help speed up documentation. Printouts for patients are typically handled by clerical staff. There are quite a few hospitals that struggle with both implementation and operationalizing workflows to make this actually work, but it's how things are supposed to work. In practice, the IT teams do a middling job of setting things up and training users, the physicians are old and don't want to do the work, the government regulations are burdensome and make the whole thing more cumbersome and unintuitive than it needs to be, and the result is a boomer doctors declaring that computers are stupid.

Yeah I was more aiming for your General Practitioner (GP) in a clinic having a printer at his desk and potentially a notes template with letterhead ready to go. Smash out 5 x 1 line dot points summarising your advice on how to manage their condition and have it auto save into their file.

If it isn't as easy as that it won't get done. You'd be lucky to get some unintelligible scribble notes on a sheet ripped out of a physical notepad even if you requested it.

These five bullet points will get padded out with 10,000 bullet points of ass covering and the end result will be no one reading it because of course the medication is known to the state of California to cause cancer, what isn’t?

This happens a lot in our own fucking notes we used to share mission critical information with each other (called note bloat), pretty much zero reason to assume it will have the smallest usefulness for patient facing stuff (for the reasons you outline).

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