Articles on Medicine...and One on Amtrak (Mar 2012)

It has been awhile since I link-blogged, but I think I have a few interesting ones lined up, so here goes:

A few months ago, Wired published a nice long article looking at science, correlation, and causality. It uses the failure of the drug torcetrapib as a lead-in example, and also discusses some interesting stuff on diagnosing back pain. Read here.

The NYU School of Medicine has begun to supplement its anatomy classes with computer simulations. The future is here. It won't replace traditional dissection labs completely, but has a lot of potential to enhance medical education. (New York Times)

Biomedical engineering? How about an artificial heart that doesn't beat? The amazing story here, courtesy of Popular Science.

Now that you're all read out, consider taking some real time off from the world. This Washington Post columnist writes about her experience on a cross-country Amtrak trip, where the destination was the journey.

Patients or Cases?

I'm glad to see that medical schools are incorporating activities to reinforce the human side of medicine, which, in today's rushed pace, is sometimes forgotten.

Read Medical Students Learn to Tell Stories about Their Patients and Themselves, published in the AMA's Journal, Virtual Mentor.

IBM's Watson goes to Medical School

Remember IBM's computer, Watson, which made a showing on Jeopardy a couple months ago? It's moving past game shows and looking to assist doctors. Watson would fit perfectly with the move towards electronic patient records, but it will be interesting to see how Watson affects the role that a doctor will play in medicine.

Articles on Medicine (May 2011): Beyond Diagnostics

Just two this time.

• Are patients just interesting cases, or are they people capable of emotion?


• People talk about treating the root cause of a problem and not just its symptoms. Social causes should not be forgotten, either.

Doctors and IT

Well, first of all, this blog is not dead. It has just...undergone a period of deep hibernation. Unfortunately I don't think I'll ever be able to keep up with it as much as I used to, but I'll still try to post here more often than I have in the past few months.

Today, I read an interesting article intersecting technology and medicine: U.S. patients trust docs, but not e-health records, survey shows

As someone who is on the road to a medical career, it's certainly encouraging to hear that most people trust their physicians. But as a technologist, it's also worrisome to hear that patients don't always trust electronic health records, and that the lack of trust can be justified. On the one hand, a doctor's job is to be a doctor, not to worry about computer and network security, which is the job of an IT specialist. On the other hand, digital security is a real problem that every computer user has to worry about to some degree. I don't know if most doctors are aware of IT security best practices, but it is more likely that most doctors can't afford to hire an IT team to run systems and security, nor do they have the time to learn and deal with it themselves. As much as EHRs have their benefits, I can see how they become a burden as it takes considerably more technical know-how to maintain than a filing cabinet; correspondingly, hiring someone to maintain an EHR system is more costly than hiring someone to maintain a filing cabinet.

It seems that computer security is becoming increasingly important in the healthcare industry with the push for switching to EHRs. The simplest solution would probably just be to isolate EHR computers from the internet, but that runs counter to the collaborative ability to share EHRs between health organizations. As a result, doctors will probably need to have a higher level of security awareness than the average home user, simply because the stakes (i.e. protected health information as defined by HIPAA) are much higher. While I by no means claim to understand how EHR systems are being deployed, my guess is that, like other enterprise software, the software is developed and deployed by a software company that maintains an active support and maintenance contract with the medical practice. If that's the case, then perhaps those companies should include services to maintain a network where there is otherwise no dedicated IT infrastructure or staff, and at least provide minimal training materials to doctors and their staff so that the digital security issues that have plagued other industries ("Big Company loses SSNs and credit card numbers of 1 million customers due to network breach") do not now begin to affect medical practices. One way or another though, it would seem that, in general, doctors need to gain a better understanding of computer security than they have now, for the good of their patients.

Articles on Medicine (Oct 2010)

Well it's been awhile since I posted anything here, but I'll try to get back into writing some stuff. For now, I'll catch up sharing some interesting articles I read over the summer.

• Advances in biomedical instrumentation enable a portable mini-lab.
  
• Live in a city? Take some time to get away to a more natural environment.
  
• Trade some study time for exercise.
  
• There is lots and lots of medical waste, thanks to the popularization of disposable supplies. Many hospitals are now seeking to reduce that quantity.
  
• Scientists are good at science, but medical doctors need to be better at more than just science.
  
• Hospice care and discussions about end-of-life plans are not "death panels." If you haven't discussed this issue with your family at all, don't wait until it is too late. (This is a long, in-depth article, but is a good read nonetheless.)

Articles on Medicine (Mar 2010)

Really now?

Simulation-based training, something I'm a little familiar with from my Emergency First Responder training. And yes, it's not just the technical skills that are important. The teamwork and communication skills are often the harder ones to practice abstractly.

End of life, hard decisions

Doctors on Haiti: NYTimes, American Medical News

Articles on Medicine (Feb 2010)

A commentary on the influence of Western medicine in understanding mental health in the international community.

The human side of being a doctor: here and here.

There may be some cases of physician malpractice, but sometimes you need to let go. RIP stands for Rest in PEACE. And that doesn't mean cause trouble for those left behind.

Be careful with analysis of cost-effectiveness. You can't easily reduce everything to numbers, in this case relating to end-of-life care.

Some More Articles on Medicine

Related to health care reform:
An existing example of something that works
Reform and the Health Care Workforce — Current Capacity, Future Demand
What Hopkins medicine has to say
A case for evidence-based medical practices

General:
Medical schools are revising their curriculums
On the mindfulness of doctors

Articles on Medicine

Interesting articles on caring for seniors:
The Patients Doctors Don't Know
Experiencing Life, Briefly, Inside a Nursing Home

The Dog-Eat-Dog World of Applying to Med School - sort of a med school version of an earlier blog post I wrote about applying to college.

Are you reading this blog post at 2am in the morning? Have a look at this.

We can detect cancer, but what should we actually do about it?

And on the topic of healthcare reform, what Hopkins medicine already does.

Prosthetics 2.0

Or rather, optogenetics. It's been awhile since I've posted here since I've been busy with schoolwork. I'm still busy, so I haven't really written anything substantial despite my to-do list of things I want to write about. But I did want to share the following biotechnology article, which I found interesting:
Algae and Light Help Injured Mice Walk Again

Google Apps and Privacy

About a week ago, there was an interesting Slashdot posting about privacy of data and Google Apps, specifically in respect to HIPAA compliance and legal liability. Based on the very interesting train of comments, it seems that using Google Apps for medical data would not be HIPAA-compliant because the data is not stored in an encrypted form. I certainly don't claim to be very familiar with either HIPAA or Google's Terms of Service, but that does sound like it could be a problem.

More importantly, though, is the point raised that Google employees can read your data. This is something that most people don't really think about. I had an interesting conversation with a fellow TJ student once. As a sysadmin, I had access to the mail system, and I mentioned that the nature of having administrator access was that we could read students' TJ e-mail if we wanted to, but that we were highly unlikely to do so. This student wasn't very comfortable hearing this, so I also brought up that using any other mail system like Gmail had the same issue. For some reason, this person was more comfortable with strangers having access to her data than a fellow student. If I remember correctly, the rationale was that some information (e.g. personal relationships, etc.) could be more damaging in my hands than in the hands of a total stranger. At the same time, that's saying you would trust a random stranger with your most personal secrets more than you would another responsible student (because becoming a student sysadmin is not as easy as "here you go") at the school you attend. And yet, as illogical as that seems, more and more people opt to go this route. For instance, people will blog or post things online but then are surprised when other people find it and it gets used against them (the classic example is a prospective employer finding an embarrassing photographs of or information about you online).

Back to the original topic, then. While Google Apps offers a lot of benefits, including low cost (it's free unless you opt for a premium version) and familiarity (just about everyone has a personal Gmail account and finds Google products easy to use), there are times you want to consider the implications of putting things in the hands of people that you don't really know. There is a reason, after all, that passwords and other sensitive information aren't supposed to be sent in e-mails. But let's say that every employee that works for a company handling your data is trustworthy. You still have to deal with the possibility that data is accidentally mishandled or lost, because even with the best intentions, accidents do happen ("lost laptop with thousands of Social Security Numbers" ring a bell?). That is, after all, the definition of an accident.

So the next time you choose to use a public service for storing or transmitting potentially sensitive information, consider not only the benefits, but also the implications of doing so. And if you're in healthcare, I advise you to do your research thoroughly, and consider whether or not your patients would approve of the way your data is being handled. But who knows, these days it's possible plenty of people would be quite happy with their private health information in the hands of computer nerds they've never met.

Not My Spleen!

The spleen is apparently more useful than once thought.

Healthcore Costs, Doctors, and Salaries

There have been some interesting articles recently about health care. The point about the value of prevention is an old one for me, but the salary vs. fee pay system for doctors was something I had not heard about before. I'm not sure which is better since my experience in comparing the two is limited, but I think what any healthcare reform needs to boil down to is patients first, not profits. I'm not going to deny that the limited sources from which I read these articles may provide a biased view, but it seems that in the cases presented, improving patient care led to a reduction in healthcare costs, without cost savings being a primary goal.

References:
NYT: Getting Good Value in Health Care
NYT: Hospital Savings: Salaries for Doctors, Not Fees
NYT: Forget Who Pays Medical Bills, It’s Who Sets the Cost
The New Yorker: The Cost Conundrum