Informatics Pioneer Says Healthcare Needs Better Systems

Numerous reports have shown that the medical profession is responsible for hundreds of thousands of preventable deaths a year, according to medical informatics pioneer Dr. Lawrence L. Weed.

"Where's the outrage? You get one plane crashing and it's on the evening news for days. Well, there's no outrage. No one's investigating it," Weed said during a rare appearance at the Healthcare Information and Management Systems Society (HIMSS) last week in New Orleans.

Weed, 89, has been advocating -- often to deaf ears -- for the computerization of healthcare because he strongly believes the human mind simply is not capable of remembering every nuance of medicine and disease without assistance from what we now know as clinical decision support systems.

"The public thinks that you know all 70-odd causes of chest pains," he told a rapt audience of mostly fellow doctors during a HIMSS symposium on physician informatics."They think we know all 70 causes. They think we know the five or six things about each cause that you should check on a routine history and that you can keep score in your head and say, 'Mrs. Jones, I think you've got such-and-such,'" Weed said.

"There's not a doctor in this room who would stand up and say, 'I know all of that,'" according to the longtime University of Vermont educator. "What does that mean? We're all playing with half a deck," Weed continued. "No two doctors ever play with the same part of the deck and no one plays with a full deck."

The reason, according to Weed, is a fundamental flaw in the way medical education is set up.

[ Want to know more from HIMSS? See EHR Interoperability A Hot Topic At HIMSS. ]

Weed, who created the problem-oriented medical record and the SOAP (subjective, objective, assessment, plan) note recalls one student asking him why airplane pilots are so willing to undergo such rigorous training, testing and discipline, but medical students are not. "I said, 'Well, it's because the pilot has to get in the plane. You don't have to go up on the operating table,'" Weed said, to considerable laughter.

Weed said he developed the problem-oriented medical record because he needed a system. "The worst, the most corrupting of all lies is to misstate the problem. Patients get run off into the most unbelievable, expensive procedures ... and they're not even on the right problem," according to Weed.

"We all live in our own little cave. We see the world out of our own little cave, and no two of us see it the same way," he added. "What you see is a function of who you are."

Knowledge is in books and literature, and patient information is in the history and physical, but there's a "gulf" between this information and a "transmission line" that leads to physician action, according to Weed. Being thorough and reliable are important, for sure. "But those are like Sunday school platitudes until you have a system. I can't teach until I have a system," Weed said.

Medical students are taught a core of knowledge, not a core of behaviors. "You're developing a discipline of not being very thorough, reliable. If you get 60% or 70% in those national board exams, you'll get that MD and eat. You won't know why you were learning it, you won't use it rigorously, but you will get authority," Weed said.

"We have an education problem. Nobody went through four years of medical school and all that expense to do the wrong thing, and it's not very pleasing to be told about it," he explained.