EPtalk by Dr. Jayne 5/8/25

Farewell, Skype, parting is such sweet sorrow. Not really, since I hadn’t used it in years. In fact, I had forgotten that I even had a Skype account and didn’t remember until I went to the website to try to grab a logo.

I exported my contacts and there were only three, which makes sense since it was a personal account and not the corporate one that I last used in 2018 or so. Supposedly all contacts and conversations were ported to Teams, but I didn’t see them there. Skype was founded in 2003 and headquartered in Luxembourg, which I don’t think I knew when I was a user. It just goes to show that no matter how cool you think your solution is now, there’s a chance that it won’t be around in a couple of decades.

I had a routine trip to the dentist recently and was pleased to see that they had incorporated some newer evidence-based recommendations into their treatment protocols. Apparently they have also upgraded their imaging system, because it’s now using AI to flag areas of concern on the images. I got a kick out of listening to the dental hygienist explain what the AI was doing and how the goal was just to draw the viewer’s eye to areas that needed additional attention and that the AI was not practicing dentistry.

She knows that I’m a physician, but probably not that I’m an informaticist. Regardless, I’m glad that she didn’t make assumptions about my knowledge and did the same educational talk she likely gives to all the patients. The AI flagged areas that I knew were already concerning, so at least it was concordant with my history. I enjoyed being able to see and discuss the images instead of how things used to be when x-rays were still on tiny pieces of film.

I also had a visit to a new consulting physician and was reminded how difficult it is sometimes to try to put yourself in a “just be the patient” mindset when you know what the best practices are in the industry. The receptionist was friendly, but jumped straight into some screening questions that were straight out of 2021, including whether I’ve traveled outside the US recently and whether I’ve been exposed to anyone who has been sick in the last 30 days.

The answer to the latter was, “I’m sure, given all the bugs that are going around,” but it’s really a nuisance question unless you’re asking about particular kinds of illness. I was around someone who later tested positive for Influenza B, but that was two weeks ago and I’m asymptomatic, but I doubt the receptionist wants to get to that level of history. I’m also sure I’ve been exposed to COVID-positive people given the wastewater numbers in my area, but it seems that no one is testing at home any more and people are likely just walking around with viral symptoms. She also asked if I had been positive for COVID in the last ten days, which was more relevant, but again if people aren’t testing, they’re unlikely to know.

The office visit was uneventful, although the practice could benefit from a few patient-centric tweaks. The exam room had a bulletin board with a handful of flyers attached, but it was across the room from the patient chair, so there was no way to read it without walking over to it. At that point, you would be behind the door if someone opened it. The flyers were also bad photocopies in small font, so they weren’t terribly welcoming to patients who need readers or other visual aids.

There was only one patient chair, leaving no place for family to sit and no place to put a purse or tote other than the floor, which I don’t like in a medical facility. The physician asked about my job, and once I said “clinical informatics,” I got an earful about his dislike for ambient documentation. Apparently he’s been burned by hallucinations and the need to spend excess time doing edits, so he is phasing it out in practice. He’s in a subspecialty where every detail can have meaning, so I’m not surprised that he’s meticulous as far as his note content.

After the consultation, I was sent across the hall to the hospital-owned lab and made a beeline for the “sign in here” poster that points to a clipboard. The receptionist interrupted her conversation with another patient, turned to me, and said “You can use the kiosk.” She pointed over my shoulder to a kiosk that was on the wall behind me, next to the door that I had just come through, but positioned in a way that I wouldn’t have seen it entering the room. I think a sign that says “please check-in on the kiosk behind you” might be in order, since I heard her do the same thing several times while I was waiting.

I was also unamused to see a dirty waiting room with crumbs and dirt on the floor at 7 a.m. If one were giving the benefit of the doubt, one could think there might have been a patient eating a messy breakfast in there. But based on the distribution of the mess, it’s more likely that whoever is mopping is just pushing things back under the chairs since it was also all over the waiting room. I guess I’m just a curmudgeon expecting healthcare facilities to be clean. Still, I know from my leadership roles that it’s difficult to hire these days and also difficult to ensure quality. Still, if I were this facility’s manager I would be embarrassed.

From there, I went to a non-medical appointment, where I was also asked to check in via a kiosk. This time it was more visible to the average customer. I got a kick out of the fact that the “title” picklist in their system included such options as “crown princess,” “baroness,” and “viscount” and was very much tempted to use one of them just to see if it would raise eyebrows. Since I’m generally a rule-follower, I went with a more appropriate choice.

By the time I finished that appointment, I was already getting lab notifications from my patient portal, which was pretty surprising given the kinds of tests that were ordered. Some of the more obscure ones actually resulted faster than the standard chemistry panels, which is unusual. I suppose the speed and accuracy of the results might outweigh the state of the waiting room, but I guess that’s just healthcare in today’s world.

What’s your definition of clean? Do your facility’s floors shine like the top of the Chrysler building? Leave a comment or email me.

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