I am in the "bash on" camp, but it probably depends upon what you intend your substack to be. Obviously, the other courses have a greater possibility of energizing and effecting change, but my pleasure is in experiencing, and learning from, your varied interests (even when I don't understand the math). So I vote for "general education" over "advanced studies," but you should do what brings you joy,
I would just like to share the Singapore experience with the American electronic healthcare system, the infamous EPIC. I think the most likely cost of the failure of EPIC is that, like most American systems, it is design not for the welfare of the primary and uses, meaning the healthcare staff, but for the profit makers, meaning Pury merrily the medical insurance company and D for profit, owner of hospitals, clinics, and other healthcare institutions
It would be interesting to compare the systems used in other countries maybe primarily China to see whether they have done better
Maybe I can share my own experience with the system in Singapore before EPIC came along
That system was designed by a group of medical professionals who are IT savvy, one of whom is a good friend of mine. That was excellent.
I would love to hear your experiences in as much depth as you care to share, especially as I have formed my own firm opinions about Epic, which may or may not be correct---others' ideas are even more valuable in these circumstances.
Please feel free to email me directly if this suits you :)
I enjoy reading most of your articles. I am not in the healthcare industry or a scientist so a lot of it is over my head but I muddle through it to try and expand my thinking. I am a programmer so I can relate to your thoughts in those areas. I also appreciate your outside view of the political mess the US is in but I haven't seen any of those in a while from you.
Jo, I like your ideas, but I think the best item to focus on is the one with the best chance of actually effectuating something. I don't know how hard it is to fix Journalocracy, but I'd give IT a go. As long as there's a way to advocate, link up, get Med IT companies and government to want it, etc.
But, "Health IT" is too broad a topic to understand. There are machines with software, record keeping, diagnostic AI, insurance and billing, informal messaging, billable physician interactions through software, information & training & perpetual change, including links to your Journalocracy dependent on patient situation, and many more. Then, there is, what information to keep, how to secure it, yet make it easy to access and ubiquitous, languages and dialects, physician Latin and patient English, and all the ways of doing health systems around the world.
So if Health IT were to be improved -- well, WHAT about Health IT should be improved? An inch deep and a mile wide would fix nothing.
You've got good insights and a thoughtful mien. The best aim for it is something that can be changed!
(I'm an Epic user as a patient, and actually reasonably happy with it. It's not perfect, there's a lot more to do, and I don't know what the physician end looks like, but it remembers everything, it seems to link doctors and health systems nearly universally and well, and has good controls, such as integrating additional physicians into my patient database.)
(I've architected some complex software systems :-)
They are all good choices. But I'd go for number two.
My own bugbear, to accompany your justified views on journals, is the completely unnecessary cost of conferences. It's almost as though we scientists are trying to exclude as many as we can from access to live exchange of scientific knowledge and debate. I organised Germany's first national conference on archaeological prospection, back in 2015, and made it free to attend just so as to make the point. It wasn't hard.
I can't see any justification in charging more than the minimum required to make an event run smoothly. I don't want a tote bag or fancy food. I certainly don't want a beautiful programme and a pen if, as a result, the cost of attendance is high enough to exclude students or the wider public.
High time for a Cheap Conference movement in my view, though it's not a hill I'd die on.
What do you mean by the 'Computerising Medicine'. If it's something like the dispensing system used in some UK hospitals (a machine that dispenses medication according to a prescription input into it, responsible for overdoses (in my actual experience, good job I always check my meds because the nurse sure didn't, relying solely on the computer). Or the GP system where you have to fight for meds if you're going on holiday? Or something else entirely? Because this particular minefield is of great interest to me.
I would be in favour of "bash on" as my primary interests are all things medical. That said I like learning about the other topics you write about as I'm not often exposed to those issues. At the end of the day I would say just make yourself happy. I for one will continue to enjoy whatever you bring to my attention.
I appreciate everything you write, even the stuff way over my head. Since I am assaulted nearly every day by someone claiming this or that study PROVES their preconceptions, I am very interested in any possibilities of more easily weeding out the more egregious deceptions when I peruse the literature myself. Journal reform seems pretty foundational to any research.
I voted for the second. Not because I don’t think IT in medicine is bad or that the failure could be predicted but that I know it’s most likely the lost of the human in person interaction. As a masters prepared Nurse Practitioner that was told by various places I worked I was to slow. What they couldn't say was I was bad. And my patients loved me. I voted for number two because I think it would be the most helpful to health care providers to know that what they are reading isn’t just “crap” made to sound “right”. I doubt many have the time to read all the articles that come their way so having a rotation group of reviewers that might only review one or two articles ever 2 months or so and then the review is what everyone else could read and then decide to do the deep dive into the research article that made the most sense and had a validity stamp. I was very distressed to read about how fraught with errors that many of the research was being presented without validation. In my own practice I sometimes when out on a limb and didn’t some thing that “might work” not based on what I read but my own intuition. I was lucky it worked most of the time. But I never shared with colleges. Example treating post herpetic neuralgia with acyclovir when it was the only antiviral readily available. And ps it worked on me too years later.
I'd like to read your take on "medical informatics", or whatever other current buzzwords are. I remember back when "medical record systems" were a hot topic - problem-oriented medical records), SNOP (standard nomenclature of Pathology), and when we just beginning to automate medical labs. To my mind, it's a combination of "let a thousand flower's bloom", and mixed motivations on the parts of the commercial interest involved. [This is not just a problem of I.T.-izing medicine, many other failure littrer the landscape. -- see www.civilized.com/programming.html]
Dear Dr Jo, Sadly, I think you are kicking against the Pr!cks. All the time there are "Powerfull" politicians in charge of the "health system" the message will be curated by big pharma and political messages". Hence the bullshit over Tylenol and Vaccines. Don't get depressed by this; your writing is hugely appreciated* in the relatively free world (Europe, UK, NZ Etc).
I am in the "bash on" camp, but it probably depends upon what you intend your substack to be. Obviously, the other courses have a greater possibility of energizing and effecting change, but my pleasure is in experiencing, and learning from, your varied interests (even when I don't understand the math). So I vote for "general education" over "advanced studies," but you should do what brings you joy,
I would just like to share the Singapore experience with the American electronic healthcare system, the infamous EPIC. I think the most likely cost of the failure of EPIC is that, like most American systems, it is design not for the welfare of the primary and uses, meaning the healthcare staff, but for the profit makers, meaning Pury merrily the medical insurance company and D for profit, owner of hospitals, clinics, and other healthcare institutions
It would be interesting to compare the systems used in other countries maybe primarily China to see whether they have done better
Maybe I can share my own experience with the system in Singapore before EPIC came along
That system was designed by a group of medical professionals who are IT savvy, one of whom is a good friend of mine. That was excellent.
I would love to hear your experiences in as much depth as you care to share, especially as I have formed my own firm opinions about Epic, which may or may not be correct---others' ideas are even more valuable in these circumstances.
Please feel free to email me directly if this suits you :)
Dr Jo.
I enjoy reading most of your articles. I am not in the healthcare industry or a scientist so a lot of it is over my head but I muddle through it to try and expand my thinking. I am a programmer so I can relate to your thoughts in those areas. I also appreciate your outside view of the political mess the US is in but I haven't seen any of those in a while from you.
Jo, I like your ideas, but I think the best item to focus on is the one with the best chance of actually effectuating something. I don't know how hard it is to fix Journalocracy, but I'd give IT a go. As long as there's a way to advocate, link up, get Med IT companies and government to want it, etc.
But, "Health IT" is too broad a topic to understand. There are machines with software, record keeping, diagnostic AI, insurance and billing, informal messaging, billable physician interactions through software, information & training & perpetual change, including links to your Journalocracy dependent on patient situation, and many more. Then, there is, what information to keep, how to secure it, yet make it easy to access and ubiquitous, languages and dialects, physician Latin and patient English, and all the ways of doing health systems around the world.
So if Health IT were to be improved -- well, WHAT about Health IT should be improved? An inch deep and a mile wide would fix nothing.
You've got good insights and a thoughtful mien. The best aim for it is something that can be changed!
(I'm an Epic user as a patient, and actually reasonably happy with it. It's not perfect, there's a lot more to do, and I don't know what the physician end looks like, but it remembers everything, it seems to link doctors and health systems nearly universally and well, and has good controls, such as integrating additional physicians into my patient database.)
(I've architected some complex software systems :-)
They are all good choices. But I'd go for number two.
My own bugbear, to accompany your justified views on journals, is the completely unnecessary cost of conferences. It's almost as though we scientists are trying to exclude as many as we can from access to live exchange of scientific knowledge and debate. I organised Germany's first national conference on archaeological prospection, back in 2015, and made it free to attend just so as to make the point. It wasn't hard.
I can't see any justification in charging more than the minimum required to make an event run smoothly. I don't want a tote bag or fancy food. I certainly don't want a beautiful programme and a pen if, as a result, the cost of attendance is high enough to exclude students or the wider public.
High time for a Cheap Conference movement in my view, though it's not a hill I'd die on.
What do you mean by the 'Computerising Medicine'. If it's something like the dispensing system used in some UK hospitals (a machine that dispenses medication according to a prescription input into it, responsible for overdoses (in my actual experience, good job I always check my meds because the nurse sure didn't, relying solely on the computer). Or the GP system where you have to fight for meds if you're going on holiday? Or something else entirely? Because this particular minefield is of great interest to me.
I would be in favour of "bash on" as my primary interests are all things medical. That said I like learning about the other topics you write about as I'm not often exposed to those issues. At the end of the day I would say just make yourself happy. I for one will continue to enjoy whatever you bring to my attention.
I appreciate everything you write, even the stuff way over my head. Since I am assaulted nearly every day by someone claiming this or that study PROVES their preconceptions, I am very interested in any possibilities of more easily weeding out the more egregious deceptions when I peruse the literature myself. Journal reform seems pretty foundational to any research.
I voted for the second. Not because I don’t think IT in medicine is bad or that the failure could be predicted but that I know it’s most likely the lost of the human in person interaction. As a masters prepared Nurse Practitioner that was told by various places I worked I was to slow. What they couldn't say was I was bad. And my patients loved me. I voted for number two because I think it would be the most helpful to health care providers to know that what they are reading isn’t just “crap” made to sound “right”. I doubt many have the time to read all the articles that come their way so having a rotation group of reviewers that might only review one or two articles ever 2 months or so and then the review is what everyone else could read and then decide to do the deep dive into the research article that made the most sense and had a validity stamp. I was very distressed to read about how fraught with errors that many of the research was being presented without validation. In my own practice I sometimes when out on a limb and didn’t some thing that “might work” not based on what I read but my own intuition. I was lucky it worked most of the time. But I never shared with colleges. Example treating post herpetic neuralgia with acyclovir when it was the only antiviral readily available. And ps it worked on me too years later.
I'd like to read your take on "medical informatics", or whatever other current buzzwords are. I remember back when "medical record systems" were a hot topic - problem-oriented medical records), SNOP (standard nomenclature of Pathology), and when we just beginning to automate medical labs. To my mind, it's a combination of "let a thousand flower's bloom", and mixed motivations on the parts of the commercial interest involved. [This is not just a problem of I.T.-izing medicine, many other failure littrer the landscape. -- see www.civilized.com/programming.html]
Dear Dr Jo, Sadly, I think you are kicking against the Pr!cks. All the time there are "Powerfull" politicians in charge of the "health system" the message will be curated by big pharma and political messages". Hence the bullshit over Tylenol and Vaccines. Don't get depressed by this; your writing is hugely appreciated* in the relatively free world (Europe, UK, NZ Etc).
Hi Tim,
Of course I am. And the only thing worse than kicking against the pricks is not kicking against the pricks.
We all need to do what we can, however tiny. Dr Jo.
Of the three the last one IMHO represents the one where an actual "FIX" is most likely and would have the biggest effect