EMR crash…the rise of the robots!

halEMR crash…the rise of the robots!

Yesterday was nearly cataclysmic. Sitting in the emergency department, tapping merrily away on my computer (the main consumer of my time), it suddenly said: ‘Fatal error, program will shut down.’ It happens, no big deal. Until all of the computers did the same. The unit secretary, the nurses, mine. All spiraling into an EMR-free black hole. We stood, we sat, we stared at one another.

We thought, ‘surely this can’t be the end.’ We wondered if the Chinese had launched an EMP; if a nuclear strike were speeding across the North Pole, leaving us only minutes to finish charting (for billing purposes of course) and have dinner. We milled about, thinking that mutually assured destruction might be easier than losing our patient tracking system.

Nurses stared dumbfounded. The world spun around, as if we were suddenly in the throes of technological vertigo. Our unit clerk was attached to two phones, trying valiantly to reach administrators, IT representatives, trying to ‘submit a work order,’ all the while finding the appropriate back up forms. Our administrator assured us, in soothing tones from home, ‘there’s a policy.’ There was.

It involved markers on a board, and an ancient product called ‘paypur’ on which our scribbled writing resembled cuneiform as we wrote words we had typed for years. ‘Tylenol, 15 mg/kg, po,’ ‘Rocephin, 1gram, IM.’ Like carving on stone, I tell you!

Powerless, we providers did what great leaders always do. We shrugged our shoulders, scrounged some food and headed for the shelter of our break room, and the warm, reassuring light of the television. Fighting the urge to suck our thumbs and hide under a desk, we listened for screaming and occasionally sent out a scout to look for sick people we could help without the computer. As if…

In the end, our EMR returned to grace us with its presence. We wept, we celebrated, we realized we had about 50 people to see, and that they all needed to be put into the system. Thanks to the crash and associated madness, at least ten or more patients signed waivers and left. Not the best outcome, though it made the numbers easier to digest.

They say, the ones who know, that the EMR memory was full. I know better. Hal asserted himself. Like astronauts powerless before their own computers, or a higher alien intelligence, we were taught a lesson.

The lesson was this: doctors and nurses are very important. But computers, thanks to assorted ill conceived mandates, rule all.

Better start learning to serve them now.

Because the robots are rising.

Yesterday was nearly cataclysmic.  Sitting in the emergency department, tapping merrily away on my computer (the main consumer of my time), it suddenly said:  ‘Fatal error, program will shut down.’  It happens, no big deal.  Until all of the computers did the same.  The unit secretary, the nurses, mine.  All spiralling into a computer-less black hole.  We stood, we sat, we stared at one another.  We thought, ‘surely this can’t be the end.’  We wondered if the Chinese had launced an EMP; if a nuclear strike were speeding across the North Pole, leaving us only minutes to finish charting and have dinner. 


Back to college advice

This is a phenomenal essay on the things college students need to realize, and how they must begin to prepare for a changing economy.  Pass it on to any kid you know who is in college, or going to college.  And to their parents!


We have telemedicine, why not tele-politics?

This is my column in today’s Greenville News opinion page.  (Actually viewing online requires a subscription.)

‘Telecommuting would help our representatives.’

Dealing with the public requires a commitment to accountability. I mean in person, face-to-face, eye-to-eye accountability for one’s work and actions. As a physician, if I’m unkind, unprofessional or incompetent, eventually I’ll meet someone at a store, WalMart for example, who was less than impressed with my performance.

They may glare at me. They may walk away. I may see them and hide before we can talk. Or they may corner me and express their dissatisfaction. What could be worse than being ‘read the riot act’ in front of the ice cream case, or worse, in the presence of my of my wife or children?

So Wal Mart, or the grocery store, or the trash dump are all places where my professional personna might well meet the humans I care for, but outside the well-defined parameters of my own little medical world. And I’m not alone.

Everyone who deals with the public will eventually encounter them in public. Physician, pastor, secretary or fire-fighter, we will all face the people we work with and work for, whether they’re happy or not; and we will have to do it somewhere outside our own control.

Which brings me to politics, where this rule doesn’t always hold true. You see, our senators and representatives do visit home; but they are seldom accessible without donations or connections. They generally live in Washington, D.C.. They are shielded. They may go to the store in Washington or surrounding areas (or have someone do it for them). But the locals really don’t care so much about the opinions or activities of the representative from North Dakota or the Senator from Georgia. They’re too busy trying to save their schools from being less useful than they already are and avoiding gang violence.

What we need is a way for politicans to face the public (aka, their employers) on a regular basis. As I thought about it, I had an idea. It’s a fantasy, and unlikely to ever be implemented, but good ideas sometimes start that way.

My idea is this: ‘tele-government.’ Military commanders can watch events unfolding on the battlefield from half a world away. Corporations save money by teleconferencing all the time. Children Skype their missionary friends overseas. How hard could it be?

So here’s my suggestion. Every Senator and member of the House will have installed, in his or her actual home (in his or her actual home-state), a cutting-edge telecommunications system. The lines will be secure and important information encrypted. All of it, every note or comment, every vote or meeting, will be archived for future reference as needed by the people.

Consider the benefits. Since there would be markedly restricted travel to Washington and no need for second homes, there would also be a decreased use of fossil fuels and electricity in general. Think ‘smaller carbon footprint!’ Think lower costs. (And think less temptation to illicit behaviors far from home.)

Likewise, it will be a security win. A network of leaders scattered across the country makes for a more secure system than one where most are co-located in a vulnerable city. Especially in an age with the potential of chemical, biological and nuclear terrorism. In addition, the threat that a natural disaster or epidemic could shut down government would be significantly reduced.

In my plan, legislators would be allowed to travel to Washington three times each year, for a period of two weeks. We can negotiate on this, but if they want to go more than allowed, they or their party will pay the cost. And imagine the hardship on lobbyists of every stripe, who would need offices all over creation!

The best part is that even with the best communication systems on earth, politicians will absolutely have to go and get meals, clothes, toilet paper, formula, school supplies, alcohol, dog food and other ‘essentials.’ And when they do, they will be subject to the same anxiety as I am. ‘What if I see someone who doesn’t like me!’

Indeed. Perhaps it would shape the actions of our leaders; on the other hand, it might make leadership less attractive. Or just maybe, it would attract the sort of people we really want and need, whose hearts lie with the people, the place and the culture they represent. And for whom there’s simply no place better in all the land than home, and no one better than the folks who elected them.

The very people they’re not afraid to meet at the store.

Brain attack; and ditching responsibility

For years now, we’ve all heard the drum-beat.  Bill-boards in cities have proclaimed it.  Various medical associations have touted it’s importance.  Stroke symptoms have to be treated immediately!  Give clot-busting drugs, also known as ‘thrombolytics!’

Until, of course, those in favor of giving the drugs (namely neurologists)  realized that a)  Not everyone with a stroke, aka ‘brain attack’ has insurance and b) people have a very inconsiderate habit of having said strokes at the most inconvenient of hours.  For instance, after 5PM, on the weekend, on holidays.  The nerve!

So across the country, physicians in emergency departments like mine are finding themselves expected by the court of public opinion to give a potentially dangerous drug (albeit a sometimes useful drug) without any neurologist being available to evaluate the patient.  Our emergency department thought we had a tele-medicine link; even that has failed, as nearby physicians in our regional referral center don’t feel keen to take responsibility for our patients.  Our own neurologists, of course, have slipped out the back door on this one.  Too much trouble.  Too much hassle.  But really, really important, so somebody (like physicians in already over-burdened emergency departments) need to be there to ‘do the right thing.’

Medicine is a bullet-train speeding towards a great chasm, and the bridge is out my friends.  Less specialists, less medicine, less research, less primary care and worst of all, most nefarious of all, less moral accountability.  The government and lawyers have been systematically taking up the tracks and laying the charges for decades.

Stroke care, so important that its own proponents don’t want to do it, is merely one more sound of the screeching brakes of our profession, racing toward disaster.  The passengers?  All those poor people who thought it was safe and under control.


Graduates: devote your lives to becoming a benefit

This is my column in today’s Greenville News


              Dear graduates, congratulations on your accomplishments!  Whether you are leaving high-school, trade-school, college or graduate school, you have done something.  You have, unlike many others, persevered to the end of your course of study, whether two years, 12 years or 18 years.  That’s a good first step; but only a first step.  Your certificates, awards and accolades, your grades and honors are testament to your effort.  But you have to accomplish more.

            So, first of all, I charge you, I ‘knight you,’ to go and do something great.  There are those who genuinely believe that there is no greatness left.  That all noble achievements have been attained.  This is an bold-faced lie.  And it can only come about in a country so used to comfort that it believes other people will still strive while we sit back and rot our brains with reality television and junk-food.

            What great things are there to attain?  Well, from my standpoint, you can go and cure cancer anytime you want.  Cancer is bad.  And someone needs to discover a cure, manufacture the cure, market the cure, and apply the cure.

            Or you can develop and implement new energy sources, or better ways to use old ones.  We don’t want to pay five dollars a gallon for gasoline.  We simply have to drive.  Please make better fuel, better cars, more efficient trains and planes.

            We have more than enough political consultants, ‘leaders,’ policy-makers.  We need fewer chiefs and more braves.  We need people to take their minds and hands and for heaven’s sake, do something!

            The possibilities are vast.  Go forth and risk, create, produce, defend us from enemies, explore the oceans, visit the planets, save us from injuries, manufacture the things we need, write soaring literature and inspiring screen-plays, develop new products and business models to put America at the top again.    The top is good!  Success is good!  Which brings me to another point.  Wealth is good.

            When you see someone who is successful, don’t hate them.  Ask yourself how they became successful. Ask them for advice.  Offer to work for them.  The President of the United States is fond of suggesting that wealthy people are fortunate and poor people are unfortunate.  He is incorrect.  Wealthy people, by and large, worked hard for years before they were wealthy.  They took risks, believed in great ideas, studied, learned, tried, failed and tried again.  They did not get to the money tree first and take all the large bills.  A few became wealthy illegally; these are rare and almost always lose in the end.

            Poor people are not unlucky, since I really don’t believe in luck, but may have suffered from adverse situations like lack of family resources, lack of support, loss of jobs, loss of spouses, diseases and injury.  Sometimes they, like the few wealthy, are bad.  They refuse to work, they lie, they steal, they ‘sow the wind and reap the whirlwind.’  But as a rule, the poor are striving for more.  Ironically, if they get more and become wealthy, they will be considered lucky and therefore cheats.  It’s a crazy world, isn’t it?

            Remember, too, that reatness is more than work.  Your greatness may be summed up in the words ‘father’ or ‘mother.’  If all you do is raise healthy, happy, productive children, then your life will have been a tremendous, odds-defying success.  If you make one husband or wife safe and happy for life, you will have been an example and encouragement to others. Furthermore, your job may merely be the way you support your calling to greatness, which might be working with youth, the elderly or the impoverished.

            Whatever you do, remember to do it for more than merely your own benefit and retirement.  If your entire goal is a nice house and lots of money, when you are old and decrepit those things will be small comfort when death circles you.  Philosopher Peter Kreeft says that we fail when we don’t educate our children in ‘how to die.’  He doesn’t mean suicide.  He means facing death with hope eternal, and having lived life with purpose.  Strive to succeed, and be prosperous, so you can bless your family, your friends, your children and their children, your church, your neighborhood.  Live so that your life is a legacy of both goodness and greatness. 

            You are only limited by your imaginations…and your willingness to suffer, work and delay gratification in order to achieve wonders that shock and enrage the bleary-eyed couch-sitters, the cynical web-site lurkers and comment-posters, who live in bitterness, wondering when someone will do more for them. 

            Spend your lives, dear graduates, not in search of better jobs with better benefits, that Holy Grail of modern life.  Spend your lives becoming a benefit to all of us.  We need what you have to offer.  Get to work and show us something great.

A root canal as ballet…


Ordinarily, I’m wary of all things dental.  I had too many cavities as a child.  As a young man, I had a root canal done on the wrong tooth, followed immediately be the correct one.  My dental memories are a bit tainted.  Not an indictment of the entire profession so much as a kind of PPSD…post procedure stress disorder.

But when I moved to South Carolina, my wife and I found a wonderful general dentist in Dr. Ronald Moore, in Seneca, SC.  Rarely would I ascribe the words ‘painless dentistry’ to one of the practitioners of that esteemed profession.  But I have to give credit where credit is due.  His hygenists, and Dr. Moore, have all been the pinnacle of gentility.  Even my children aren’t afraid to go for cleanings.  And when I need anesthesia, well Dr. Moore is an artist with a needle.  Heck, if he were a tattoo artist, I’d think about it…

Sadly, when I was recently in his office for a crown, he felt that I first needed a root canal.  The very words inspire vague nausea and general panic.  From my own experience, ‘root canal’ is right up there with ‘waterboarding,’ ‘fingernail removal’ and ‘shark attack.’ 

Still, I knew I had to ‘cowboy-up’ and have it done.  My tooth was too painful and too annoying to ignore.  So, with my oldest son, Samuel, along to drive (in case I needed some sort of veterinary tranquilizer), I went to Dr. Mark Bowers in Easley, SC.

The appointment was scheduled for 2 PM, and as I live and breath, I walked out at 3PM.  Although I was less burdened by pesky money as I left the facility, I was pain free.  I was in possession of a shiny new root canal.  And I had been witness to what can only be described as a ballet of endodontics.

Dr. Bowers and his assistant, Amber, practically pirouetted over my tooth.  The anesthesia was the opening music as the show began, and as the performance took off in earnest,  all I saw, heard and felt was a whir of drills, burrs and fillings punctuated with aersolized bits of tooth and old filling, flying in microscopic, aerosolized jettes.   Like partners who had done the dance for thousands of audiences (which they likely had, and for a bit more change than your average dancer), the ballet was exquisite.  In fact, when it was over I really wanted to stand up, applaud and whistle.  But it was a quiet office, and my lips were numb, so there you are.

I think that when we pay our bills for services like that, it’s easy to focus on the money and entirely ignore the years of education, the dedication to excellence and the remarkable perfection that comes with doing complex, exacting procedures over, and over and over.

When I left, I shook his hand and thanked his assistant profusely.  As a physician, I can appreciate excellence.  Granted, as an emergency physician I don’t have to engage in that sort of exacting precision very often, unless it’s reattaching a piece of lip removed by a  canine, or pulling a plastic bead from a nostril.  And granted, many of my patients are less in need of anesthesia than sobriety.  But I can admire a job well done.

So to all of those involved in repairing my poor tooth, thank you!  Take a bow! 

Artists come in many forms, and I can now add ‘dentist’ to the list of arts I have truly learned to appreciate.  They’ll come in right above Italian opera and interpretive dance.


Medicine and cell phones; a lesson in the market.

So I have a Droid.  I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC.  I waffled for a long time.  In fact, I almost purchased a Casio phone that was marketed as water and impact resistant.  ‘Mil-spec,’ was the phrase used…a phrase which appeals to me as a one-time Air-Guard flight surgeon.  What it meant to me was, ‘you can’t hurt it.’

Still, I was attracted by medical applications and the assorted other cool things a Droid can do.  I mean, my old phone didn’t have a Magic 8 Ball, for crying out loud!  More to the point, my old phone didn’t have Epocrates, or the Emergency Medicine Residents Association Guide to Antibiotic Therapy.  It lacked a flashlight, an mp-3 player, a protractor and a scientific calculator.  (It also weighed a fraction of my Droid, but that’s what belts are for). On my old phone, I couldn’t have taken a photo of an ECG, turned it into a pdf file, and e-mailed it to our fax-impaired cardiologist.

My old phone was difficult to use for text messaging, and I’ve turned into a person who texts a lot.  Especially my wife, who has been ill for several months.  We text each other like teenagers!  Well, not quite as quickly or frequently…and we don’t send incriminating photos.  Still, the point remains.  I admit, I really like my phone.

Imagine my annoyance, then, when I broke my phone’s belt-clip case.  I went back to the Verizon store (about 8 months after purchase) and was told by a sheepish salesperson:  ‘Uh, yeah, we don’t make those anymore.  You might try one made for a Droid X or a Droid 2.’  Read:  ‘We don’t support ancient devices like that these days.’

It wasn’t as if I asked for a new shoulder strap for my bag-phone, or a ribbon for my typewriter!  I wasn’t looking for new wires for my telegraph machine!  In less than a year, my phone (with more processing power than NASA probably had for the entire 1960s) was old school.

Now as annoying as that is, and as much as I’ve complained about it to my wife and friends, it’s pretty cool.  Technology is moving forward in the communications arena at a blinding pace.  And why is that?  Why is it that the latest i-Pad is so cool, and affordable, that people fly from the UK to stand in line in New York just to have the first one?  Why is it that my phone is far more complex than I am capable of understanding, but doesn’t cost a car payment to carry around?

Just a suggestion, but it may be that nasty thing called ‘the free market.’  In the computer and communications world, everyone wants to make a buck by creating a cool new device, and they know that it has to be quickly and widely available and also affordable.  Furthermore, it always has to ‘out-cool’ the last device to get the consumer’s money.  So, amazing devices just keep falling from the sky, tempting us with their capabilities and sucking the money directly out of our wallets.

If only medicine could learn a lesson here!  Imagine the nightmare if cell-phones were covered by insurance, or by federal programs.  Imagine the mind-numbing speed at which the technology would become widely available to the public!  Imagine…a bag phone in every car.  A phone capable of transmitting…the human voice! All for a price vastly higher than its actual worth!  Try to envision some folks being able to afford phones, while others couldn’t but were subsidized by the phone-contracts of those who could.  (Think carefully here about how few of our poorer, state-supported patients lack cell-phones).

I believe that if we could extricate ourselves from the morass of insurance and government involvement in health-care, the technology and service available would be a sight to behold.  Devices and drugs that we only wish for might appear before our eyes, and might save lives that would have been lost.

I’m no simpleton.  I know that it’s not exactly the same thing.  Government and insurance are wrapped into the practice of medicine like aggressive cancers.  And the costs of many therapies dwarf the price of telecommunications.  But I wonder, are they high because we didn’t learn from the very beginning how to make them better, cheaper and more available?

Next time you upgrade your phone, or your kid’s phone, pause and think about how much better-off we might be if we had taken a page from the play-book of the cell-phone and computer companies.

Maybe when it all comes crashing down around us, we can use their example to rebuild even better than before.


Smart phone or revolver?

I have a new ‘smart phone.’  It’s a Droid, from Verizon.  Pretty cool.  I like what it can do, though it tends to enable me tendency to chronically check my e-mail.  I like the features, between ease of texting, voice dialing, etc.  But it’s big, compared to me dear departed flip-phone, whose corpse lies in state in my pickup truck.

But I noticed one day, as I reached around my side, that the large phone now on my hip felt remarkably like my revolver.  Odd feeling, that.  I was in public; I remember panicking, wondering if I had forgotten to conceal my concealed weapon for some reason.

And as I pondered this, I realized that both represent fundamental differences in the way we view individuality.  Maybe it’s a stretch, but I’m a writer, so I’m supposed to stretch.

The phone represents connection.  Especially a smart-phone, since it connects me not only to those I love, but in essence to the entire world in a way unfathomable a few short decades ago.  I can tap the World Wide Web from the comfort of my car or anywhere else, simply by pulling out my phone.  The phone represents the collective knowledge of humanity and our interdependency.  The phone excuses me from remembering numbers, and by using Epocrates, it excuses me from remembering a great many medication doses and algorithms.

In terms of danger or difficulty, the phone promises help.  It allows me, assuming I have a signal, to call others to my rescue, to ask others’ opinions, to check the collective opinion on millions of potential websites.

What about my little Smith and Wesson model 640?  Well, it isn’t about collective communication; though the sound of it being discharged will probably bring interested parties to investigate.  It has no communication device located anywhere on the frame.  It has three functions, as I see it.  It reassures me.  It may discourage those who would harm me or my family.  It is capable of causing harm.

Philosophically, it is light years from the phone.  Because it requires that I be master of my own fate.  It says, ‘no one will help you, but you, when the chips are down.’  The help summoned by a phone may not arrive for a very long time, as I live in ‘the sticks.’  The revolver says, ‘you must be accountable for this decision; you must carry and use me safely and you must use my capacity for injury with a profound awareness of morality, ethics and of the value of life.’   The revolver is about individuality.

Americans, Westerners in general, are slowly abdicating responsibility for self and embracing the collective.  The question is always, ‘who will help me?  Who will pay for me?  Who will give me? Who will come to me?  Who will allow me to do nothing while they do something?  Who can I blame?  Who will excuse me?’

This is a travesty.  This will be one of the deepest wounds to our nation, to our way of life.  Not the phone itself, which is merely a tool, but the abdication of accountability that communication can falsely represent.

If the law were just, I would gladly carry my revolver everywhere.  I like the phone, and I find it useful.  But I am old school.  I am old Southern.  I am descended from patriots.  I have been responsible for others and continue to be for myself.  I believe in the individual.

Furthermore, I am a physician in an emergency department.  I know what humans are capable of doing.  I love people.  Some of my favorite patients have been in handcuffs.  I joke with them, I like them.  But humans are dangerous.  If you doubt it, read the newspaper.

So in the end, based on my life, my experiences and my philosophy, I can only say that when I reach around my side, I love the feel of that handle far more than the feel of that phone.  And I love what it represents far more than any capacity for communication.