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Thursday, June 15, 2017

The Sour Grape

I have been told by at least one person (and I think many more might have the same idea) that "I have disregard for postgraduate entrance examinations and am working where I am currently working like it is something heroic because I find entrance examinations difficult to crack, because I'm incapable of getting a good rank, and I am just finding excuses that I can't figure out what postgraduation to do, that I don't want to lock myself in a garage to learn".

To them I would say, maybe you are right.

Maybe I am an idiot.
Maybe I barely passed MBBS.
Maybe I should not have been a doctor on the first hand.
Maybe I do not have the aptitude to crack entrance exams.
Maybe I am not even smart enough to do the "right" things in life.
Maybe I am stupid.

But, guess what?

I don't care.

My choices are entirely mine. My outlook is formed by my thought processes and I can live with the same. Maybe I don't fit your definition of success. Maybe I don't fit your definition of smart. I don't care.

It is my life. And I will choose how to tread it.

If your idea of successful and smart is to eternally run behind happiness in a pattern that is set by the expectations of the community. Pity you. I am happy where I am. And I am confident of being able to find happy places throughout my life. I don't need your free advice on what is the smartest thing to do.

Do I sound arrogant? Well, that's your problem to solve. Because if you feel like you have been smitten, it's exactly you whom I intended to smite.

You think I will learn myself? Yeah I will. I might some day come back and write entrance exams. But I won't be writing it for you. I will be writing it for myself.

I am in control of my life.
Don't try to wrestle that control away from me.

You can try to unsettle me and shake my confidence.
Well, thank you. But it doesn't work on me.

You know why?
Because my strength lies in knowing what I am doing.

My future is uncertain. But I'm comfortable with uncertainty.
My ideas are abstract. But I can think in abstract.
My philosophy is impractical. But I can make it work.
You may be right. But dare you say I am wrong.

Monday, June 5, 2017

My Idea of a Perfect Electronic Medical Record System

The COWs are coming to our hospital.

No, not these. They're getting more attention than they deserve.

Our hospital might soon switch to an Electronic Medical Record system. And this will bring in Computer on Wheels, COW as they're affectionately called in other hospitals.
More like this
While that makes me more happy about where I'm working, it also brings back a lot of ideas I've had during medical school. I have seen hard problems for humans that are pretty easy for computers to solve. I have seen processes that could be hastened by leaps and bounds if computers were involved even partially.

The Perfect Electronic Medical Record System

The perfect EMR does not just record what the physician or nurse puts in. It is an intelligent assistant that does some thinking of its own and comes back with suggestions and autofills for the physician or assistant.

For example, when a child comes to you and her mother says she has fever, you start entering "fe..." and the EMR autofills fever. Next you can enter the duration from a dropdown menu. Also associated symptoms can be ticked "yes/no". As you're done and move to the next row, the computer automatically populates an entry - "Cough? Yes/No". If you choose yes, it asks you for characterization.
If at any point you're in doubt or do not want to characterize a symptom, you can just delete the autosuggestion and move on to the next line.

Once you are done with the symptoms and exhausted the negative history that the smart EMR suggested for you, you can enter the examination findings. Again the EMR will suggest for you the most important findings you should not forget to look for based on existing data on what the most common findings are for that particular set of complaints.

Later, the computer will show you a list of provisional diagnoses based on the data you've entered about the patient, and the past set of data the computer has, and even the compendium of knowledge that it potentially has access to. You can reorder the diagnoses if you like.

Accordingly the computer will suggest investigations and management plans with dosages calculated according to weight or dosage adjustments that are required for special conditions.

The computer will always suggest and ask you for guidance when in doubt. You can always override the computer, but you can also take computers help in not missing important things.

Such a system might not be useful for an expert clinician, but it will definitely help a new doctor in emergency rooms late night. Most importantly, the system makes sure that an exhaustive history taking and examination has been done. It also helps in making clinical decisions based on data and evidence.

Impossible?

Certainly not. I just discovered that Dr Lawrence Weed, MD has been saying this exact thing since years. He might even have developed such a system already. But EMR systems do not seem to have this kind of intelligence integrated yet.

The accuracy of simple software powered by big data like Akinator is testimonial to the power of computers when it comes to problems like this.

Clinical decision making is no holy grail and it will soon be heavily relying on, if not replaced by, artificial intelligence.

Pictures courtesy pixabay.com