Information at Your Fingertips

“Despite what you read, Jaded Julie, health care is a lot better than it used to be.”

“So, Curmudge, is that your professional opinion?”

“Nope, it’s my conjecture. That’s a better word for a fictional person. Consider this example: When I was a kid 70 years ago, the doc-with-the-black-bag couldn’t drag around a medical library when he made a house call. When he encountered a patient with unfamiliar symptoms—me—he could only rely on his experience, or as we say now, he had to ‘wing it.’”

“Since you are still with us, I congratulate your parents on their choice of family physician.”

“Fast forward to the present. Everyone knows about the power of CT’s and MRI’s for diagnosis, but I was curious about what is available in the readily accessible literature.”

“By ‘readily accessible,’ Curmudge, you mean just a couple of mouse clicks away.”

“Exactly, and I found a ton of stuff for physicians, midlevel (advanced practice) providers, nurses, pharmacists, and people writing about health care. Some of these are available only by purchase, such as the Isabel Diagnosis Reminder System (1) and several from Wolters Kluwer Health [5-Minute Consult Database, Drug Facts and Comparisons®, Evidence Based Guidelines, Lippincott’s Nursing Procedures and Skills, and several others] (2). The Institute for Clinical Systems Improvement has order sets and algorithms for diagnosis and treatments available on their website (3). Closer to home, we have Affinity policies and preprinted or standing orders for hundreds of diagnoses, evidence based treatments, and procedures. To obtain this treasure trove, I just talked with a few people and rummaged around in Google. Just imagine how much more could be obtained with a literature search done by the St. E’s or Mercy library.”

“Now I know why you were huddled with your computer for the past two weeks. So what good is all this?”

“The physician with his handy computer or personal digital assistant will no longer have to ‘wing it.’ If necessary, he can check a diagnosis or medication during the patient encounter or perhaps after the fact to confirm his decisions and monitor the quality of care he provides (4). Nurses and managers can use the evidence based procedures in these resources as the basis for standard work in any of the patient care areas of the hospital.”

“I understand, Curmudge, that we are already using the preprinted orders in our hospitals. Their check-the-boxes feature serves to remind the physicians of the latest evidence based therapies. When a physician overrides a pre-checked box, it must be justified. These forms also minimize variations in provider prescribing practices and critical aspects of patient care.”

“That’s it, Julie. I hope you now agree with me that health care has improved over the years.”

“Curmudge, you were fortunate to have survived old-time medicine, but I suspect that was not always the case.”

“Here’s another personal example: The same doctor who used his vast experience to cure me of gosh-knows-what in the 1940’s also brought my mother into the world in 1899. He was at the bedside of her mother who died of gosh-knows-what in 1902. So my mother, at the age of three, lost her mother and I lost a grandmother that I never knew.”

Affinity’s Kaizen Curmudgeon

(1) http://www.isabel.org.uk/pdf/Product_Release.pdf
(2) http://www.clineguide.com/Common/PDF/ClineguideMobileReleaseFinal.pdf
(3) http://www.icsi.org
(4) http://www.ama-assn.org/amednews/2009/06/29/prsn0629.htm