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Given such a source of current medical information, indexing the relational database could offer an ongoing differential list of diagnostic possibilities for each-and-every sign, symptom and laboratory finding. Despite advances in medical science, missed diagnosis continues to plague the profession. A correct and timely diagnosis seems more likely with instant access to lists of all the possibilities, criteria for diagnosis and brief summary. Statistical analysis of those lists should be ongoing and real-time offering simple probabilities for both single positives and combinations. This statistical process will be essential for assimilating genomic data and applying it to personal medical care.
Traveling to a conference or accessing journals presents problems of time and money for a rural physician. A limitless source of medical information at the fingertips would help. The generalist must fill the gaps between specialties and cover a broad spectrum of medical challenges. A total medical information system would help met that need. Proprietary systems like Epocrates provide some of the needed medical information. None of the proprietary systems, however, list everything, nor do they have the ability to stay current. Furthermore, marketing and often greed motivate the content; they emphasize drugs and treatment more than diagnosis. Medical schools need to provide an umbilical cord for the student and to the lifetime of the graduate physician regardless of the specialty. We have an obligation in medical education to lead the way and to a pursuit of excellence.
Educators do not seem much interested in the clinical
viewpoint of medical education, so here it is anyway. Medical education equates
to the delivery of medical information -- much more than it is possible to
teach. Medical schools should be
obligated to provide current medical information from the first year of medical
school and throughout the life of the graduating physician --- Current forms of
accessing medical information, CME or GME are completely inadequate and
obsolete, locked up in copyright, cost and limited by the distribution of the
printed text.
Currently there is no real-time source for the total sum of medical
knowledge and the leading edge of information growth. Physicians and students
alike need such a source that is up-to-date, real time, 24/7. That source
should contain it all, terminology and diagnostic criteria as currently understood
by the medical school and the specialties.[1]
Every medical school should provide total medical terminology, information and current knowledge
for every one of their student, residents, graduate and physicians under their employ at no cost by secure 24/7 online access.Given such a source of current medical information, indexing the relational database could offer an ongoing differential list of diagnostic possibilities for each-and-every sign, symptom and laboratory finding. Despite advances in medical science, missed diagnosis continues to plague the profession. A correct and timely diagnosis seems more likely with instant access to lists of all the possibilities, criteria for diagnosis and brief summary. Statistical analysis of those lists should be ongoing and real-time offering simple probabilities for both single positives and combinations. This statistical process will be essential for assimilating genomic data and applying it to personal medical care.
Information technology offers an unlimited repository of
knowledge accessible through a relational database. The computer never forgets.
It lends itself to statistical analysis, but it does not think. Thinking is the job of the student and the
physician. That critical clinical thinking and the basic sciences remain the
educational challenges of the medical school. Medical information is so vast
and so rapidly changing, however, that it has long since grown beyond the capacity of any
one physician to learn and forget much less to remember.
Today in the real world the physician is met with time constraints, productivity demands and repetition, all of which discourage discovery and lead to missed diagnosis. Diseases and treatments fall into familiar patterns. A hundred and fifty, or so, conditions fall easily into a recurring pattern of diagnoses. A one-page encounter form can cover the needed ICD codes required for insurance. That recurring pattern, however, erodes away the physicians heard earned clinical acumen. We often overlook rare disease possibilities and there are so many of them with new discoveries all the time. Additionally, increasing numbers of Immigrants bring in problems common to their home country but only now cropping up here in the US.
Physicians keep up to date with expensive seminars and long
hours reading expensive journals at home but nonetheless slowly fall behind. The
older a physician grows, the greater the clinical judgment but the more he or she forgets. The
content shrinks. Today in the real world the physician is met with time constraints, productivity demands and repetition, all of which discourage discovery and lead to missed diagnosis. Diseases and treatments fall into familiar patterns. A hundred and fifty, or so, conditions fall easily into a recurring pattern of diagnoses. A one-page encounter form can cover the needed ICD codes required for insurance. That recurring pattern, however, erodes away the physicians heard earned clinical acumen. We often overlook rare disease possibilities and there are so many of them with new discoveries all the time. Additionally, increasing numbers of Immigrants bring in problems common to their home country but only now cropping up here in the US.
Traveling to a conference or accessing journals presents problems of time and money for a rural physician. A limitless source of medical information at the fingertips would help. The generalist must fill the gaps between specialties and cover a broad spectrum of medical challenges. A total medical information system would help met that need. Proprietary systems like Epocrates provide some of the needed medical information. None of the proprietary systems, however, list everything, nor do they have the ability to stay current. Furthermore, marketing and often greed motivate the content; they emphasize drugs and treatment more than diagnosis. Medical schools need to provide an umbilical cord for the student and to the lifetime of the graduate physician regardless of the specialty. We have an obligation in medical education to lead the way and to a pursuit of excellence.
[1] A word of caution, often overlooked by
non-clinical educators, information should be limited to medical students and
graduate MDs --- those with the ability, education and dedication to care for
patients. Providing that information to various assistants and alternative
providers will cut off the supply and even the existence of Primary Care Physicians.
Another mandate that should go without saying but today is often ignored;
physicians must all freely exchange information techniques and knowledge between
one another.
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