Being different pays off, that's the moral of this awesome video (open in new window if it isn't animated!). That's also the moral of my post below. I want to introduce to you a concept which is generally considered uninteresting and dull but once mastered has a huge potential to make you a better doctor in all ways. You can work faster yet more efficiently, you can enjoy your work better and you can earn more spare time. Fast and easy solutions are sexy but easily forgotten - I promise you this one is utterly unsexy!
How technology has evolved and is now everywhere50 years ago a huge box from IBM was carried on an airplane - it was a supercomputer which had 5mb of memory - barely enough for a single mp3 song. Today's USB memories are capable of 1GB, that's about an 30.000% increase. Looking at the Nasdaq index from 1970s we see a boom as PCs and later Internet invades homes and becomes mainstream - no technology ever has had such impact on our daily lives.
We started attending our financials using Internet banks so driving to the bank and queuing became a thing of the past. Emails replaced slow-mails and through IRC we could chat real-time with the other side of the world. with Web 2.0 social networks started evolving with and by then the IT revolution was so integrated in our lives that most of us have forgotten there ever was a revolution.
Since smartphones invaded our pockets we now have a supercomputer within reach of our hands 24/7. Computers and information technology (IT) is now all around us - whether we like it or not. Fortunately we can still choose how much technology should be integrated in our daily lives and some prefer the old filofax and reading books the old way. Combining both worlds might be the best - and in my opinion necessary if you’re a doctor.
Everybody's in the party - except the docAll these advancements have led to enormous changes in our society, the Arab Spring (ignited by Twitter) is one great example. The public has now powerful tools in their hands - the Web 2.0 is all about the ‘power of the people’. Information is easily spread and communicating with all corners of the world is now a breeze.
There are many smaller revolutions taking place, the rise of the e-Patient is one. It’s the patient who is well educated about his or her disease and is aware of the importance of his/her own responsibility of disease progression e.g. by keeping track of own medicines and making lifestyle changes. For the same reason people nowadays will ask the doctor’s about their diagnosis not their symptoms (for better or worse!)
Medical students are breaking history as they on grand rounds test the wise and old specialists - the wheels are turning. Not because they’re better trained but they just have grown up in a world of much more accessible information and stimulation, they’ve adapted to e-Learning.
The most important question is - have doctors adapted as the public has? If we had a Nasdaq-MD index, would we see the same boom for doctors’ efficiency? Have we become e-Doctors? Should we?
Doctors need technology - technology needs doctorsWe have a healthcare system that is bloated like after eating a super-size McDonalds meal. Diseases are slowed down and treated creating an older, more fragile population challenging the classical presentations taught in the books. Emergency departments all around the world are being overcrowded and much more complicated case presentations require more local resources of which there are not enough of. The 90y/o patient with a history of 10x previous PCIs, presenting with chest pain, is now common. Only 10 years ago hardly any doctor would even consider coronary imaging of patients that age. Technology is supposed to solve Earth’s problems such as ever increasing consumption of raw materials and energy - certainly the same must apply to healthcare. The problem is just that we are being thrown into this future without being trained or educated. It has been said that since electricity was invented, it took 40 years to see measurable productivity increase on corporate level. Looking around in the hospital, I'd guess it will take 80 years until doctors use modern computer technology properly.
We are flown abroad to expensive international conferences for relatively minor changes in clinical practice but nobody bothers to train us to touch-type for 2-3x faster text writing, yet we write notes all day long. Nobody helps us with keyboard shortcuts or finding information efficiently and so cumulatively, millions of non-productive hours of the world's most expensive workforce is spent away. At the same time, badly designed IT systems are thrown at us e.g. EMR software that is non-intuitive, hostile and error prone. I've seen colleagues miss crucial background information about a patient because they didn't know how to switch databases - and we're being sued for ridiculous things such as 'missing a normal lab value'.
As a consequence we’re being shifted from bedside to desktop care. Doctors and patients both complain that computer and IT work is replacing time spent with the patient. We have entered a promising technology revolution but it’s backfiring in its early stages.
Certainly there’s a lot of system failure to blame but what I’d like to say to you is this: take the controls - master the technology yourself. YOU learn how to be more computer efficient, YOU learn how to type faster and use keyboard shortcuts, YOU bring your favorite conferences to your laptop with e-Learning - it’s easy and it will definitely make you a better doctor!
Let's put it another way. If a bloated healthcare system, crowding etc. is our biggest threat and about 50% of our time is spent at the computer screen - doesn't it make sense to make all this time more efficient?!
As end-users of complicated IT systems we should be active, not passive, to provide the necessary feedback to designers needed to improve them. Remember how often you've said to your self "it's so frustrating, I never get any feedback on my patient work, what should I improve?". It's easy to complain but difficult to give feedback.
You may be able to dodge the first waves of the revolution but in the end it will get you, sooner or later you will have to get involved.
A few examples of tech in practiceThe tech revolution is not just confined to your workplace or even your personal computer. Used correctly it can help you a lot in all aspects of your life. Following a few personal examples of how tech skills have helped me personally
- A paper-free/all-digital and online office means omnipresence of my notes, documents, images, videos etc. Wherever I go I have instant access through my smartphone. For viewing or editing. Everything I learn new I add to my notes, for example I still review my notes from cardiology rotation 5 years ago, on the train. Bedside, my smartphone provides instant access to important details I've previously learned but forgotten - my personal ultrasound notes are a great example.
For the same reason I have all my personal documents and correspondence since about 15 years back in a "digital drawer". It's a tickling experience yet exciting to read old love letters!
- Writing 80-100 words per minute on keyboard gives me great advantages in administrative work. I write notes in real-time and I am free from a 1980s technology, the tape recorder. Thus I finish my passes on time and my skills in working with digital information such as text and multimedia opens up many new doors to improve my ED.
- I can instantly reply to emails - having an almost empty inbox takes a lot of stress out of the day. Knowing the inside and out of Gmail I filter mail so that only important ones alert me on my phone.
- Having my www link collection in one place, accessible from everywhere. This for example allows me to help patients find information online and saves me lot of time explaining details. Informed patients fare better and will decrease 30 day readmission rate.
- Mastering the search engines I quickly find information I am looking for. 'Googling' is just the top of the iceberg!
- I've never lost important data and never had a virus or malware of any kind. I don't do backups but sync my digital office data to the cloud instead so that it's not only backed up safely 24/7 but also accessible everywhere for both viewing and editing.
- I've never had a problem with lost password and keep track of all PIN codes in a secure way with my smartphone.
- I use Linux, my laptop is nearly 5 years old yet faster than the newest Windows 8 model from the shop. I spend <$20 on software per year yet everything I use is legal and state-of-art.
- Knowing the social media tools available I administrate at least 5 special interest groups of various kinds, free and with minimal attending time.
- I never miss meetings or important dates at anytime have instant access to my work or personal schedule.
- Despite all this, I've ran a marathon, swum in the ocean, got married, had three children and enjoy a great life!
To summarise, what my tech/IT/social-media skills have brought me comes down to one concept: doing more with less work. Eliminating repetitive tasks. You can learn that too if you only have interest and patience!
Where should I begin?Since you are reading this you have already achieved the most important element - curiosity and interest. Now, you only need attention and training and training takes time and patience - the sole reason why so few doctors have worked on improving their tech-skills! But you've got this far and realised how much there is to gain. Remember, the most important is that you are interested and willing to learn more, that's how Daniel LaRusso mastered his karate training.... wax on wax off!
First of all you'll have to welcome a new mindset. Computers take orders and you are their master. If a computer doesn't do what you want you have to look back and see what you did wrong. You also have to be open to new ways of getting your things done. And train some.
When teaching colleagues I usually start with going back to basics because that's where you have most potential for improvement! This involves the following:
- Mastering keyboard and mouse, the alpha and omega of getting things done on the computer.
- Mastering text manipulation; you work with texts all day long and you want it to flow faster.
- Master your web-browser. This is your one most important software, the one you interact with all day long and the door to the rest of the world.
- Master the data cloud and wep applications for paperless office which goes with you wherever you are.
- Master email and chat tools for secure and fast communication with your personal and professional network.
- Master social-media for faster and better medical education and establishing contacts with like minded colleagues globally.
Most importantly you have to be curious and willing to learn. You can copy-cat your neighbour, buy an iPhone & Mac and go with the flow - but then you've learned nothing and truly are driving a Porsche blindfolded.
In this blog I have covered all the most important aspects of tech-skills, IT and social-media, step by step from basic skills such as keyboard training to starting your own social-media network. You won't learn it all in one day and not in one week. But you'll definitely make improvements every day.
I hope I have inspired you to give it a try. Please send me questions if you have any, check out my intro page for email address and more.
A great blog for beginners as well as more experienced doctors wanting to dwell into social media.
- Make use of
One of my favorite tech blogs with focus on productivity tips and hacks.
Same here, a little more general, with real-life hacks and tips.
- The rise of desktop medicine
Describes the sad shift where doctor is treating patients through computers instead of bedside. Many of the comments are well grounded too.
- How Time is Spent During an Emergency Department Shift An emergency physician finds out almost 50% of his time in a shift is spent at the computer screen!
- The rise of the e-Patient
Excellent summary of what the e-Patient is.
- Remember also to check out the 'mentionable posts' section (top menu)