HEALTHY ONLINE

High Tech people are very enthusiastic people. We are optimistic, confident and creative and if I may be allowed to say so, really, really smart. We start out by saying “Hello World!” not “Hi, I’m Jack or Jane”. We hail the entire Universe and assume it knows who we are, or that it will soon find out, because the sky is not the limit and we are going to change the world, all at once. We don’t wear pocket protectors or duct tape on our spectacles. We wear defiantly baggy clothes; have tattoos and piercings in all the right places, ride motorcycles and listen to the latest music. Actually many of us are former or part-time musicians, or at least dabble in painting, spiritual philosophy and sometimes even a little writing. We don’t make telephones or missiles or coffee makers, but we make your phone smart, your missile guided and your brew master programmable. We solve problems and sometimes we get carried away. Back during the heyday of the Certification Commission for Health Information...

“There were two men in one city: the one rich, and the other poor….. “ (II Samuel 12:1-12) Thus begins the story of King David’s punishment for robbing a simple man of his life and of his one beloved wife. I have had the incredible fortune of being taught the Bible in the City of David, probably a stone throw away from where he perpetrated a sin that haunts his people to this very day. I was taught the Bible not as a divine text, but as a political, historical and philosophical manuscript written by ancient sages, and David’s story was not about the perils of philandering. It was about the disastrous results of social injustice. The story is not a Socialist manifesto. The Bible in its entirety accepts the fact that there are rich men and poor men and David was not admonished for not redistributing his riches equally amongst the poor. The line of decency is crossed when the rich and powerful wantonly decide to take away the poor man’s “one little ewe lamb” , not to love and cherish as t...

Like most home buyers, I toured the house with my family, checking closet space and bathtubs and finally descended into the basement to see if it has any potential. It was a very large and dark basement mostly unfinished, but the scene in front of us was breathtaking. Thousands of glass jars and bottles of every conceivable shape and color, sparkling clean and neatly stacked in groups by size and shape, some in small pyramids, on a myriad of shelves, small tables and wooden crates. There were no labels on any of them and there were no tops. The ex-Marine Sergeant who built the house in the fifties and lived there ever since, must have spent a lot of time cleaning, processing, sorting and arranging glass containers for what seemed like an awful lot of years. Why did he do that? What did he see in those glass mazes he built in his basement? I never found out. We bought the house almost eight years ago, and had a “guy” come by and remove everything that was not nailed to the walls before ...

Dr. Gawande has a new article in the New Yorker suggesting that hospital chains may very well be the solution to our health care problems. Dr. Gawande has a very engaging writing style and in addition to writing for the New Yorker, he writes books and delivers memorable speeches and he is also a surgeon at Brigham and Women’s hospital in Boston. In recent years, Dr. Gawande’s writings have become the cornerstone of health care policy and none more so than his 2009 New Yorker article explaining the inexplicable health care cost explosion and the variability of medical expenditures across the nation. As the New Yorker itself proudly noted , President Obama himself had a most fortuitous epiphany after reading the New Yorker article, and summarily decided that “This is what we’ve got to fix.” In “The Cost Conundrum” Gawande explored the differences in expenditures for Medicare beneficiaries in two Texas towns whose names became synonymous with our health care issues, the expensive McAlle...

Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of Dr. Eric Topol , is the “essence of digitizing a human being”. Dr. Abraham Verghese , named this digitized entity iPatient and expressed concern that the “iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record”. Whether you share Dr. Topol’s enthusiasm or Dr. Verghese’s worries, or experience a combination of both, your medical digital self, has been born. And nurtured by leaps and bounds in technology, it will soon grow to loom as large as your shadow at sunset. Today’s el...

If you are like most physicians in this country, you probably bought yourself an EHR, either recently or a while back. If you are like the docs quoted on the various EHR vendor websites, you took to it like fish to water and are thoroughly enjoying your new computerized system. If you are like most other physicians, you are slugging your way through, a bit slower than usual, with a bit less money in your wallet, either hopeful that things will get better or perhaps still hopeful that this is just a bad dream. If you are like most EHR users, you probably compromised on an EHR that seemed to be not as bad as the others, compromised with the documentation style seemingly imposed by your EHR and are now dragging a tablet from exam room to exam room, and that tablet gets awfully heavy after a few hours of seeing patients. Perhaps you found nifty little ways to “cheat” and leave the tablet in your office, or maybe you broke down and installed desktops in your exam rooms, or perhaps you tried...

When the hypothetical naked, unconscious and alone patient presents at your ER with no immediately evident reasons for his distress and presumably holding his driver license between his clenched teeth, would you find it helpful if you could see a nicely typed, or hand written, list of diagnoses and current medications for this hapless person? When a family moves across the country and brings in their eight year old for her first visit with the new pediatrician, would it be helpful to see a slightly fuzzy image of her immunizations list from back home? When an elderly patient you’ve been seeing for umpteen years is shipped to the hospital in the middle of the night, would it be helpful to find the admission record in your to-do list for today?                                          ...