Larry Weed's 1971 Internal Medicine Grand Rounds - and quality management in health care generally

[SNT Gatchaman]

Post copied from here

I don't think this has been posted already. It's 1 hour long, in black and white and from 1971. However, I think many here will appreciate the ahead-of-its-time discussion about medicine, its failings and how it could and should be done properly. I expect @Jonathan Edwards will have seen it in the past (or seen, if not given, similar such grand round presentations in real life). @rvallee, I think you would appreciate it too. I hope others find it as excellent as I did, two years ago, before I learned first hand how medicine had gone off the rails.

 

[Hutan]

Moved posts

That's a brilliant presentation @SNT Gatchaman, so many quotable bits. Sadly, it still desperately needs to be heard.

 

[oldtimer]

Terrific video @SNT Gatchaman . It makes me wonder about my own GP's records and whether paper records would be easier to navigate than computer records, or even a combination. For some things, I find I'm less likely to get lost or miss something with well organized papers rather than flipping backwards and forwards on a computer. But then I don't know what software doctors use.

 

[SNT Gatchaman]

Medical documentation and related computer systems are (very) poor. There is so much information lost, that could be gained if data was structured and systems had reliable inter-operability. In such a utopia you could imagine the rubbish questionnaire-based research we see published would be superfluous. Instead you could query and generate reports and actually measure prevalence, therapy response, adverse effects etc.

I think the only likelihood is machine learning to try and make sense of free-form notes and documents.

 

[rvallee]

Medical documentation and related computer systems are (very) poor. There is so much information lost, that could be gained if data was structured and systems had reliable inter-operability. In such a utopia you could imagine the rubbish questionnaire-based research we see published would be superfluous. Instead you could query and generate reports and actually measure prevalence, therapy response, adverse effects etc.

I think the only likelihood is machine learning to try and make sense of free-form notes and documents.

I've said it a few times but as a programmer it's shocking to me how much information healthcare systems lose. I could never accept this in a system I work on, there is simply no data integrity. The final picture is basically like applying the JPEG algorithm 10x over at 50%, if that means anything to you. The end result looks nothing like the original picture, almost all the information is irreparably lost. In some areas the information loss is 100%. This is completely unacceptable in any expert profession.

AI probably won't make much use of healthcare records, they're too unreliable other than for lab results, and only then only as reliable as those are. It's conversational AIs that will change everything. Think of having a physician available on demand, that you can talk to whenever you want to, and is able to make sense of everything you tell without losing any information, able not only to fit this information into formal records but able to go back and review the raw data, basically your full history, all symptoms and their timelines, etc.

It will basically replace the information intake process and leave the humans to work with the synthesis of all the data, referenced and formatted for easy access. No human process is able to deal with this much information, even for a single person.

This is what will change everything, when AI is conversational, able to talk to directly with people. Not just to them, but with them. Healthcare records are extremely limited compared to that.

 

[SNT Gatchaman]

From Bringing Science to Medicine: An Interview with Larry Weed, Inventor of the Problem-Oriented Medical Record

On December 28, 2010, JMcG conducted an oral history interview with Dr Weed at his home in Underhill, Vermont

I think part of this oral history is shown in this 15 minute clip: An Interview with Larry Weed, MD.

He died in 2017 at the age of 93.

 

[Hutan]

Posting on behalf of @Louie41, this video covers a lot of the same ground as the Larry Weed presentation. (And that ground is important.)

It's a nice listen although slow moving to start with. If you want to get to the guts of it, start at the 10 minute mark where the presenter, Dr Donald Berwick, imagines what he might announce if he was President of the US. It's a 24 minute listen all up.

He quotes an astonishing statistic of 1 in every 4 patients in US hospitals suffering from medical misadventure/avoidable complications - such as becoming infected with a hospital acquired disease. He, like many others, compares medicine with the aviation industry, noting how much safer it is to be a passenger in a plane than a patient in a hospital bed. He says that the aviation industry achieved high levels of safety, not by yelling at the pilots or the cabin crew, but by caring about safety and putting systems in place that have to be adhered to.

I've commented before, having some background in quality management, it's too often awful to observe health care in operation. In an area of human endeavour where quality and systems really matter, so often there's way too much chaos and too many poorly founded assumptions, and inconsistency and inefficiency. Anyway.