The Skeptical Convert 3/22/13

Weed’s Problem

After a week’s worth of somewhat manic narratives from HIMSS, recent HIStalk posts have taken a darker turn toward the adverse effects of the computerization of American medical care. Travis Good’s depressing story about his wife spending 2-3 hours a night catching up on data entry fits nicely with Ruth Bowen’s excellent piece on how her personal medical record has been chopped up and pureed by multiple competing and non-cooperating EMRs (this piece was so good, in fact, it really belongs on The New York Times op-ed page). 

I read HIStalk to get some measure of insight into a process that, like it or not, is transforming medical care. But the sense of fragmentation and chaos is demoralizing to many clinicians who do have some sense of — or at least a healthy degree of respect for — high-level degrees organization. And I mean more than just organization of our “workflows”–I mean organization of our thinking itself. We need a big thought leader, someone like Larry Weed.

Yes, those were heady days back in the 70s. Although it’s not true that there was never any serious thought given to the medical record before Weed (I recommend Eugenia Siegler’s excellent piece in Annals of Internal Medicine, unfortunately paywalled, on the stepwise and incremental developments in this area starting in the 19th century.)

Weed brought an evangelist’s zeal to his presentation of a comprehensive vision for using the medical record to transform the process of diagnosis as well as the management of treatment. It’s a shame we don’t have him around any more–he sure would have a lot to say about how things have been going lately. 

What’s that? He is still around? And he has a book out?  Funny, I haven’t seen much about it in the medical journals or the lay press. Reading this site you might get the impression he was long gone.  

But a title like Medicine in Denial seems designed to get some attention. Maybe the fact that the book has no publisher’s imprint and was copyrighted under the Creative Commons explains why we haven’t seen much attention paid.

But it, like its author, is a piece of work. You can call it a polemic, but Jeremiad gets more to of course referencing the angry language in the Book Of Jeremiah — and if that brings to mind Samuel Jackson in “Pulp Fiction” reciting those verses while pointing his Star Model B at you, well, might not be too far off.  

In fact after reading the book, my sense is that Weed would be happy to see a lot of people doing very well in the HIT field selling pencils at the corner. But don’t worry, he’d also be glad to put a lot of overeducated cognitive specialists like me right there with you competing for sidewalk space. 

But is the book any good, and does he really have any answers that work in 2013? It’s going to take more than one of these short-format pieces to get into that. This will take a bit of time, and I have a day and-sometimes-night job, it seems. But stay tuned — more will be forthcoming.  

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.