Why I quit medicine

http://gautams.posterous.com/why-i-quit-medicine

296 108 14 years ago

gautams.posterous.com

gamble• 14 years ago

Sounds a lot like the medical data startup I joined ten years ago. We were so, so painfully naive about the realities of medical software. Medical records are a trivial technical problem, but an almost insurmountable political and regulatory challenge. I knew our company was doomed when we were talking to another medical software company and saw the literal wall of binders that represented a single FDA approval process submission. It is so not a market that's friendly to startups.

untog• 14 years ago

It happens far too often. Right now I'm looking at a government RFP (request for propsals) that fits what I'm doing very well. But everyone I speak to tells me that it's an entirely doomed process, and that the government will never choose a tiny tech startup over a large corporation. I'm pretty sure they're right.

ebiester• 14 years ago

The trick is to get an intro to a big boy and be a sub on their contract. It takes some social proof (wins on other RFPs) and you really have to know people. It's an entirely different way of selling.

Government contracting really is a different world.

idoh• 14 years ago

By law many federal agencies have to give research grants to small businesses. My mom runs a physics research company and that's how they stay in business.

You check out SBIR grants - http://en.wikipedia.org/wiki/Small_Business_Innovation_Resea...

GFischer• 14 years ago

I did some very basic research for an essay on "Healthcare in the Cloud", and yes, the regulatory side sounded very painful.

Among the relevant regulations, the big ones are HIPAA and HITECH:

http://en.wikipedia.org/wiki/Health_Insurance_Portability_an...

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcem...

A big point that I remember was that a HIPAA breach was up to 1.5 million dollars in fines.

"A maximum penalty amount of $1.5 million for all violations of an identical provision"

This is one of the markets where BigCos can and should make a difference (and loads of cash in the process, but well, that's what regulations get).

On the flip side, HITECH introduced up to 20 billion dollars in incentives for adopting Electronic Health Records (EHRs), so maybe the millions in compliance are worth it for some startup :)

I got some interesting data from here ("Opportunities and Challenges of Cloud Computing to Improve Health Care Services"):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222190/

and some information by CompTIA’s Third Annual Healthcare IT Insights and Opportunities study.

http://www.comptia.org/news/11-11-16/Healthcare_Practices_Em...

harryf• 14 years ago

Wonder if smartphones open up some new doors here? Assuming doctor and patient both have a smartphone medical notes for a patient are shared but only available for doctors within the physical vicinity of the patient i.e. the patient's phone acts as the gateway to that data.

devs10106• 14 years ago

Yes, and hospitals have arcane policies / IT departments, my dad is a doctor and the hospital he works at still has Internet Explorer 6 installed on all computers there and they refuse to upgrade it for fear it might break compatibility with some ancient software program they use they access through it. He wants me to create some little software program to see if he can get them to use it when the main system goes down but it has to work in IE6 so its kind of a nightmare and I've been dragging my feet on it because of this... its things like this that make dealing with healthcare such a pain in the ass.

Thinking about this more, its actually a bit scary if I do create something and he is able to get them to use it as I could be opening myself up to a lot of liability. I figure, as a doctor, he should be aware of all this but not 100% sure how up on this he actually is, maybe I should get him to sign something having him take full ownership and responsibility of the software

dalore• 14 years ago

Why can't you code it for chrome and have the computer have multiple browsers on it?

mhurron• 14 years ago

>they refuse to upgrade it for fear it might break compatibility with some ancient software

It will break, in horrible and unknown ways, and even if it didn't if the company supporting it got wind that you used a different version of IE, or heaven forbid Firefox, that's probably enough to deny support. It's probably not even ancient software, they might have purchased it in the last couple of years. Medical software has to be the absolute worst made software on the planet.

fl3tch• 14 years ago

> the hospital he works at still has Internet Explorer 6 installed on all computers there and they refuse to upgrade it for fear it might break compatibility with some ancient software program

Meanwhile your ability to do everything else breaks through shear attrition.

tibbon2• 14 years ago

While Obama and Congress are talking about how to make regulation more business friendly, why don't they focus on day-1 problems like this, instead of IPO problems? I've never heard of a good company unable to IPO just due to paperwork/regulation, but I've heard of many company not be able to get anywhere due to silly regulatory cruft. See the TacoCopter yesterday... FAA would never let it happen. Or your medical data startup. You can fix the problem- if they will let you.

crusso2• 14 years ago

>While Obama and Congress are talking about how to make regulation more business friendly [...]

Talking != doing.

ig1• 14 years ago

Look at the stats post-SOX the number of IPOs in the US collapsed and most international companies started choosing to list in London rather than NY.

gautamsivakumar5• 14 years ago

Absolutely - there is a lot of regulation which you have to navigate and there are differences between different regions and nations. It's not the most start-up friendly market, but I don't believe that is a reason not to do it :)

nradov• 14 years ago

Typical medical records software (EMR / EHR) doesn't require any advance FDA approval.

crusso2• 14 years ago

As I read the article, I was thinking much the same thing. This guy can build the best medical mouse trap ever -- but between the government red tape, the litigious cya environment, and the slow-to-move hospital industry, it just ain't going to be adopted.

I wish it were different.

dr_5• 14 years ago

Most pure IT projects should not require FDA approval. Such approval is typically required when an actual device is involved, such as a heart monitor that connects to the patient and transmits data to the iPhone. The FDA actually has information on their site about what types of applications of this sort would require approval.

mgkimsal2• 14 years ago

Paper isn't secure, but probably more 'secure' than data on a phone, cause there's far less risk of the paper getting duplicated silently than data being pulled from a smartphone (silent sending of address/contacts, etc).

Seriously? A shared Word document? With no audit trail of who wrote what? And that is an improvement over the state of the art? It sounds like Wordpress has far more robust data management (and probably security) than what he just described.

As a doctor who can code, I'm sure the OP will be in a great position to make real change. He knows the regulatory stuff to get past, what rules can be bent, who the movers/shakers are to get stuff moved. Likely just bringing some very basic CMS/ERP functionality to medical records management in a hospital would be huge.

vannevar• 14 years ago

Paper isn't secure, but probably more 'secure' than data on a phone...

Good point. I'd also add that it's difficult to automate the process of scanning millions of hospitals for crumpled pieces of paper, whereas scanning blocks of millions of IP addresses for vulnerable smartphones is something any reasonably competent script-kiddie can do.

wisty2• 14 years ago

I see why it's important to have secure patient records. It would be devastating to have your personal medical information up on pastebin.

But you know what's worse? Dying because the doctor misses a vital piece of information which can't be found in disorganized paper notes, or a bureaucratically designed medical information system (which set the hospital back roughly the cost of a new life-saving machine).

mgkimsal2• 14 years ago

But... the dying will only happen once, then never affect you again. Leaked medical records may impact you for the rest of your life.

cchurch• 14 years ago

Dying impacts you for the rest of your life.

stoolpigeon• 14 years ago

I understand what you are saying but there are a significant number of people who are in no danger of dying who need medical care that needs to be confidential or their remaining life could be trashed.

So it's not always a choice between privacy and death. In fact I'd hazard a guess that this is the case the majority of the time.

rdg• 14 years ago

These guys need to buy this revolutionary product called a notebook. And no, I don't mean a laptop computer, but a "traditional" notebook. And probably a bunch of pens. A notebook is harder to lose than a scrap of paper and you can hand it over to the next doctor so he can read your note and add his own. Sounds interesting, doesn't it?

wvenable• 14 years ago

That doesn't really solve the problem beyond perhaps the most rudimentary way. You have X number of patients and Y number of doctors with any number of overlapping doctors interacting with any of those patients. Keeping doctors notes in a single notebook won't scale beyond a single doctor.

arn2• 14 years ago

I quit medicine too, but not because of the lack of adequate computer interface :)

The whole taking notes, jotting down patient information. It seems antiquated, but it's really a hard problem to "fix" - if it really needs fixing. These are not medical records he's talking about, but personal notes on each patient and todos you carry around with you during your shift.

Paper/pen in taking these notes is faster than computer/tablet input. I've tried it. In several different forms. There's a lot of shorthand doctors develop that help out. Arrows, diagrams, etc...

Still seems a small part of the bigger picture, which is electronic medical record keeping.

Regardless, good luck with your venture!

philwelch• 14 years ago

I wonder if this is why pen-based tablets like the Newton were so popular in medicine.

kami8845• 14 years ago

>I quit medicine too, but not because of the lack of adequate computer interface :)

If you don't mind my asking, why did you quit?

arn2• 14 years ago

short answer: had kids, and a financially successful website. (longer answer: http://news.ycombinator.com/item?id=236308 )

alphaoverlord• 14 years ago

so what's the plan doc? EHR in the style of practicefusion, drchrono, Epic, GE Healthcare?

peeln• 14 years ago

Isn't this addressed by a product like https://drchrono.com/ (YC!) or am I missing somethings?

dr_5• 14 years ago

Drchrono is an emr. I could be wrong, but I think the author was thinking of a more focused solution for a specific problem.

kyro• 14 years ago

Good on you, man.

I'm in medical school currently and the emphasis on locking down patient data is one of the most frustrating things to see. I'm convinced that it's a policy that everyone knows has little benefit and yet pushes for ethical brownie points. What's to be gained from freeing up the data far, far exceeds what could potentially be lost.

Even freeing up anonymized patient data seems to be met with opposition. Imagine the data analysis that can be done on millions and millions of patient cases and the clinical/treatment models that can emerge as a result.

Medicine right now is an old, stiff wooden board bending under the weight of technological innovation. Something's going to snap and I'm looking forward to see it happen.

I really support what you're doing, and if you want design help, my email is in my profile. Best of luck!

jerf• 14 years ago

"Even freeing up anonymized patient data seems to be met with opposition."

Unfortunately, statistically, "anonymous patient data" is an oxymoron. Any useful amount of patient data contain enough information to deanonymize it to a great extent, and in conjunction with other data often fully deanonymize.

http://33bits.org/2010/06/21/myths-and-fallacies-of-personal...

Symmetry• 14 years ago

Quite true, but that does take effort. Whatever we do we're going to have to make a tradeoff between saving lives and preserving privacy at some point.

DanBC2• 14 years ago

Ben Goldacre has a good blog post about "When Ethics Committees Kill"

(http://www.badscience.net/2011/03/when-ethics-committees-kil...)

rmk2• 14 years ago

>> I'm in medical school currently and the emphasis on locking down patient data is one of the most frustrating things to see.

Is this meant hyperbolic? Confidentiality is probably one of the most important parts of a doctor-patient-relationship. Even "statistical" information about people's health/illnesses should in my opinion only be used after prior written consent.

The potential amount of damage to reputation, social life or life (depending on circumstances) of leaked/stolen medical records/patient data redeem every effort to keep them as closely guarded as possible, in my opinion.

gautamsivakumar5• 14 years ago

Thanks very much!

Large scale analysis of (anonymous) patient information will lead to many breakthroughs. Hopefully, one day we will get there.

dredmorbius• 14 years ago

Story from a friend working at a manage healthcare company in the early 1990s.

The state published a set of anonymized data on patient care stays associated with workman's comp.

The company wrote code to correlate data from these scrubbed records (age, sex, treatment dates) with data it had, to identify the patients.

These days, much of healthcare business is oriented around data flows -- pharmaceutical dispensing machines which double as patient-data-and-dosing information capture devices. The drugs vendor is willing to sell the drugs at or near cost simply to capture the datastream and sell it back to the pharmaceutical companies.

There's very, very good reason to view EMR with strong suspicion.

Irene• 14 years ago

Kyro, your Hackermed was a nice attempt to bring together those interested in health-related innovation.

As to the OP, there's still a room to improve existing software technologies. And there is still a lack of consensus about best ways for improving handoff processes: http://www.ingentaconnect.com/content/jcaho/jcjqs/2010/00000...

dr_5• 14 years ago

Actually practice fusion seems to be making use of anonymous patient data.

tamersalama• 14 years ago

Why quitting? I see that having access to the problem gives access to numerous use-cases and ideas.

lurker14• 14 years ago

Is that really why you quit, or an engaging PR backstory?

As an entrepeneur, you'll have to deal with clogged sinks, office rentals, legal filings, and lots of other hassles similar to carrying around a piece of paper.

aqme28• 14 years ago

He didn't quit because paper is a hassle, but because he saw a significant problem in medicine that he could better solve as an entrepreneur.

neilk• 14 years ago

Perhaps you should reread the OP. He's not saying that he personally is above petty hassles, he thinks it's a problem worth solving.

I bet he also believes he can make some money too, but I don't fault him for omitting that. Surely that goes without saying.

mattwrench3• 14 years ago

This article touches on why it somewhat bothers me to see some of my smartest friends applying to med school right now. I'm sure being a doctor is a rewarding profession and the work they do is so incredibly important to their patients--but it's not particularly unique work. Medicine is the application of the already known. (Most med students are not going to be the next DeBakey.) Rather than contributing original work, most doctors seem to be well-paid (and deservingly so) blue collar workers. If someone turns down a med school acceptance, that school can instantly pull 100 names of their waitlist who will be more-or-less just as qualified.

Sivakumar is right in that there aren't many doctors who can also code. While he may not get to feel the joy of directly improving patients lives, this goal of his seems far more important to the well-being of everyone.

devs10106• 14 years ago

You can make this argument about most software developers too, while they may create unique applications, they are mainly using the "already known" (existing languages, API's, etc)... You can then go on to apply this argument to nearly any other "white collar" job, accounting is "the application of the already known", etc..

White collar does not mean that you are in a research field and pushing the limits of knowledge, from what I understand it has long had an entirely different meaning. Personally, I feel that white collar / blue collar are very outdated terms. I often feel that a software developer is somewhat of a modern blue collar worker as its a creative trade and very different from a "white collar" job such as a sales or marketing job.

mattwrench3• 14 years ago

"Blue collar" was a poor voice of words. You're right that the white/blue collar divide is not a creative difference.

But I still feel that software development is a creative field whereas most of medicine is reactive. All fields are based upon past knowledge so the use of APIs seems irrelevant since they are just tools used to create.

The criterion to differentiate between creative and non-creative fields seems to be whether multiple "correct" answers exist. Obviously in programming the solutions to problems vary in terms of algorithms,implementations, etc. On the other hand, medical diagnosis is either correct or incorrect. Even prescribing treatments seems to be more of "do X with A factors, do Y in the presence of B factors" rather than an individualized, creative approach.

kitsune_• 14 years ago

I don't know, most hospitals around here use something like SAP IS-H/IS-H MED for patient and resource management. There are yearly "eHealth summits" and similar conferences. Their IT guys are organized in user groups and societies where they share their knowledge. Is it an "enterprisey" environment? You bet it is, mainly because of the regulations. However, the hospitals definitely do not live in the stone age.

DanBC2• 14 years ago

Medical notes need to have some obvious design features common to many other computer software.

- locking: only one person able to change the record - auditing: keeping records of who read what, when, and where they did it - signing: any additions are cryptographically signed and timestamped - sharing: many clinicians need to be able to access the data across a wide range of hospital networks.

The UK NHS spent £11bn on a system which was late or didn't appear.

(http://www.bbc.co.uk/news/uk-15014288)

About 10,000 people in England die each year because a clinician makes a mistake with the meds. While that risk is very low (because there are a huge number of patients taking a huge number of meds) it'd be nice if something simple could be done to reduce that number.

gautamsivakumar5• 14 years ago

Yep, true. The NHS IT project was a perfect example of how not to do it :)

devs10106• 14 years ago

The topic of regulation that others have mentioned here makes me think of the airline industry also as, from what I can tell, medical regulations are almost as strict as those, I worked with a guy who used to do programming for devices on airliners and he said it was basically insane how much regulation there was, they were still not approved to use multi-core processors, etc so it was like programming for computers running technology of 10 years ago. I think people tend to think that healthcare would / should be much easier to use new technology for as its not quite the same as the aviation industry. However, it seems this isn't the case in legal terms and the industry may need a regulatory reform before innovation can really take place. In the case of an airliner, it really is life or death, however with healthcare, I think they can put in place enough backup systems (writing on paper, etc), even make the system do print-outs at set intervals, so if it goes down, there is a paper record right there, or something like that, so these issues can be overcome

pavanky• 14 years ago

Is it just me or does anyone else think all the doctors need is a bug tracking tool ? Preferably something that can be used from a smart phone / tablet via an app ?

jacoblyles• 14 years ago

A good example of the immense unanticipated costs of regulations, in this case patient privacy regulation.

tejaswiy• 14 years ago

You're getting it wrong I think. I work in healthcare IT and many EMRs are getting on the mobile bandwagon and building out mobile clients that let you do this.

Additionally, hospitals require doctors to put in diagnosis / treatment notes into EMRs which is usually done by transcribing service that the doctors can call or by sitting at a computer and typing it out. Although this process is worse than doing it over a mobile client, healthcare IT is not in the dark ages as people would have you believe.

devs10106• 14 years ago

My understanding is that some "hospital chains" have started doing stuff like this, primarily larger ones, however I think a lot of the smaller / independent ones are often still stuck in the dark ages as they can't afford the hassle of moving to newer technology

dr_5• 14 years ago

Not really. Ours is a small, for profit run institution, that has implemented many of these things, at a faster clip than the local multi hospital non profit institution. Ive learned that what matters most is the hospitals management and how they communicate with their medical staff.

gautamsivakumar5• 14 years ago

Respectfully, I disagree. I think there are some institutions which do it better than others - but on the whole, from a techie standpoint, healthcare IT is in the dark ages.

wging• 14 years ago

You came from Britain, didn't you? The situation there is way worse because of the NHS's failed project.

ilaksh• 14 years ago

I don't think that healthcare in countries like the UK is the same situation as in other countries like the US.

I think this article should be a cautionary tale about socializing health care.

sungam• 14 years ago

Hi, fellow UK hospital doc so fully understand the frustrations with NHS IT. I suspect problems stem from the fact that purchasing decisions are generally made by individuals (management and senior hospital docs) other than those that use the systems (in the main junior hospital docs). The other issue is that systems are implemented to reflect the way that diseases and patients should behave but there are always edge cases that do not fit into these nice boxes. Striking a balance between free-form data input, which does not add much compared to conventional paper notes, and forcing patient data into categories and drop-down boxes is a a real challenge. The other thing that is often forgotten is the amount of clinician effort required for a system. If it takes too long or is too complicated accurate data will simply not be entered in the absence of draconian sanctions from above. Anyway there is clearly plenty of room for improvement so I wish you the best of luck!

larrys5• 14 years ago

With a title of "Why I quit medicine" you would think somebody quit medicine because there is something wrong with medicine or the job of being a doctor.

What we have instead is a very well intentioned individual that is getting out of medicine because they want to run a startup. And that's fine. Maybe getting jealous because they see it as a path to riches and have been reading about to many outliers. Or maybe wanting to change the world.

But the job that he does is known as a "hospitalist" in this country. (Essentially Internal Medicine but not office practice).

http://www.hospitalmedicine.org/

My wife is one, and practices in a very modern hospital system. I've asked her many times about "the handoff (signout)" from the first time we were dating. Because it seemed outdated to me that when we were at dinner (and she was on call) she had to scribble down notes about sometimes 20 patients over the phone). But apparently the verbal interaction is important as well between two doctors and can't easily be summarized in writing. And I've overheard plenty of handoffs and can attest to the interactions between doctors and the nuance that can't be expressed in writing. (I even said why can't the other doctor just record something that you can listen to and a million other ideas and she shot all of them down very easily as not being practical. And she had every reason to support an idea like that if she thought it would make me money..)

Getting things done is difficult, and yes, they are very closed minded and it's hard to get change.

But drawing a comparison with "Considering I can talk to my smartphone and tell it to send a message to my dad or remind me to water the plants when I get home" doesn't take into account that whatever system is setup and accessed needs to be rock solid, dependable and can't fail in many degrees above your typical startup offering.

So this is a great ambitious idea that he has undertaken and I wish him well. But my guess is that he will have to partner with a health system in order to get adoption of this idea and work out the kinks and prove the concept.

gautamsivakumar5• 14 years ago

Thanks so much for your support.

You're right about how important face-to-face interaction is. That is not going to be replaced any time soon - nor should it be. But for the purpose of handover, you still need a written summary of all the patients on a ward that people can refer to. As I mentioned in the post, it would be useful to see who wrote what about each patient - so that you know who to talk to for further information. Having a handover application won't replace the morning handover meeting or a person-person handover - but it will definitely make that process less painful, more accountable and much more efficient.

(P.S. if I was jealous of the so called riches of being an entrepreneur - I would have focussed my energies on my medical career and right now I'd be driving my A5 from work rather than sleeping on a friend's couch thousands of miles from home :) I don't think anybody who takes this path should be under any illusion. Most start-ups fail and it's not an easy path. That said, I do love a lot of what building a company involves...)

larrys5• 14 years ago

If you want you can email some links to the app and I will show my wife. Depending on her reaction I might be able to get in front of some people at her hospital system. I could probably also get the hospital magazine to review it or some PR there. No guarantees but when it's ready to review send me an email.

peterbessman2• 14 years ago

Yeah... hackers are usually incredibly naive about compensation outside of their own world. For reference: http://www.medscape.com/features/slideshow/compensation/2011...

Bottom line: here in the US of A, your average doc (most certainly NOT an outlier) is making between $150k and $350k. Put that in your VC-backed pipe and smoke it.

(Debt? Between $150k-$200k for 4 years of med school. Post med school training, in the form of residency and fellowship, runs anywhere from 3-12 years and pays around the $50k mark. Basically, nobody went broke by becoming a doctor.)

Which means, of course, that the outliers can do very well. I have a friend who's Dad is an oral surgeon in the Eastern Shore of MD (what might be considered the "boonies" by some). He clears about $750k/year for a 35 hour work week. llimllib's wife above is probably around the $250k mark in the ER/ICU. If that ain't coin...

Anybody who thinks that somebody left medicine for the money knows very little about medicine.

narrow• 14 years ago

Really nice response, I think what most people often fail to realize is that it's not always about the money. True entrepreneurs are terrible at handling discomforts worst of one that could easily be fixed. I left a six figure salary in the medical field, sold my bmw and moved to SV from the east-coast to fix a problem that costs this country $300 billion annually in additional healthcare costs. It's about finding the best use of your talent.

llimllib3• 14 years ago

My wife is an ER and ICU doc. I think you're crazy thinking this guy is getting into startups for financial reasons! Anyway:

1) She consistently asserts that handoffs are the most difficult and error-prone part of the job. They take up a large chunk of her time. Further, with work hour restrictions only getting stricter, the number of handoffs is only going up.

2) While face-to-face interaction is indeed crucial, surely there are improvements to be made! Let the doctors give crucial information face-to-face, secure in the knowledge that basic patient information is stored in a trustworthy system, and you should see less errors.

> they are very closed minded and it's hard to get change.

Obviously this is a huge obstacle! But even by your own argument, there are surely ways to improve, and an ex-doctor is the ideal candidate to figure out how to do so.

larrys5• 14 years ago

"I think you're crazy thinking this guy is getting into startups for financial reasons!"

I didn't say that.

I gave three possibilities:

1) "getting out of medicine because they want to run a startup."

2) "Maybe getting jealous because they see it as a path to riches and have been reading about to many outliers."

3) "Or maybe wanting to change the world."

I referred to "financial reasons" in only 1 case. And even in that case I used the word "maybe".

That's hardly "thinking this guy is getting into startups for financial reasons".

I didn't say improvements needed to be made. In fact if you re-read what I said you will see I questioned the issues with handoffs.

jcampbell12• 14 years ago

When a hospitalist quits medicine I am never surprised.

* The job is boring

* The pay is average for a smart person

* The doctor spends a ton of time interacting with people that have sub-average critical thinking ability

These three things are something that one cannot admit in writing, but are all true. Some people just don't have personalities that can survive being a hospitalist. One way to cope is to have hobbies outside of work. Children are a particularly popular route. The author doesn't seem to be going down that path, so I think the startup world is a great way to escape a dead end job.

larrys5• 14 years ago

What are you basing your comments on?

"The job is boring"

A hospitalist deals with more difficult cases than an internist in a office based practice.

"The pay is average for a smart person"

Are you factoring in job security? And since when does "smart" equate to pay? There are tons of well educated "smart" people (who trained to be lawyers) who are unemployed or working menial jobs.

"The doctor spends a ton of time interacting with people that have sub-average critical thinking ability"

Are you referring to patients, nurses or? What do you think the entrepreneur running the local business interacts with? At least Physicians have other physicians as co-workers. Try running your own typical small business and see who you end up interacting with.

"One way to cope is to have hobbies outside of work. Children are a particularly popular route. "

Cope with what? Did it occur to you that there are people that like this job? (This is not a comment on what my wife feels by the way I'll leave that out of this discussion..)

Gatsky• 14 years ago

Job satisfaction amongst hospitalists is actually high:

http://www.ncbi.nlm.nih.gov/pubmed/21773849

Your contention that hospitalists actually hate their jobs and lie on surveys is implausible.

Medicine is lots of things, but it's never boring, especially in hospitals which are mad, mad places. Sure hospital work is not for everyone, but that isn't because it 'sucks'.

mmonihan• 14 years ago

A strategy that may have a chance, given the current situation:

1. Befriend and work with a mentor who happens to be high up in the IT department in a health system.

2. Create some kick-ass app

3. Open-source it(use the open-source version as a way for IT people in other health systems to use your work)

4. Have your mentor implement that software in their health system as a pilot project.

5. Befriend other IT directors and try to sell to them.

6. Befriend other medical software providers and try to license to them.

7. Make hay while the sun shines.

hschmidt• 14 years ago

I am a contractor at a client that does exactly that:

http://patientsafesolutions.com

Using a iPod Touch and a proprietary jacket, patients can be monitored and transferred to the next shift of nurses through an intuitive App. Its really quite amazing.

jeybalachandran• 14 years ago

Thanks for writing this article and good luck with your venture. I'm not a doctor but my company works in healthcare and deals with the same physician related problems. So believe me when I say, I understand your pain.

Passing along patient information is a tricky subject due to HIPAA-compliancy. Most patient information is transmitted via fax machines and doctors are alerted of incidents through pagers, often carrying multiple. This technology is archaic and considering 75% of US physicians own some sort of Apple product there has to be change. In particular, physicians need better forms of communication that saves them time.

I'm hoping this changes as it will impact us all. It isn't going to happen overnight but with more and more physicians pushing for change in this area, one can only hope it happens sooner. If you're interested in what my company does, check out our website at https://www.doximity.com and our blog http://blog.doximity.com/ talks about similar problems.

dr_5• 14 years ago

Things will start to change soon, there are some signs of this already. Healthcare remains heavily regulated, and because of this even for profit institutions are sometimes run as government institutions. This is most apparent in nursing facilities. Medicare is the predominant payor, and there's no reason for any facility to go beyond what medicare requires. Why invest in electronic records, etc? if medicare doesn't require it (although that's changing now). It's just an added expense.

But it's become apparent to policy makers that Medicare is getting more and more expensive, and some type of change is going to have be initiated. With private health insurance, it's the same picture. Costs are going up and more of these costs are being shifted to the insured (patients). Deductibles have gone up tremendously, and the days of the $5-$10 co-pay are almost gone.

The solution, in both cases although perhaps implemented in different ways, is going to have require the patient/insured to be responsible for paying for themselves directly. On the surface, it seems like a bad thing, but in the longer run it's a good thing. It brings into play what healthcare has been lacking - market forces. Almost all other industries have market forces in play, but not so much in healthcare. Go to a great surgeon, or go to an average one, they get paid the same. Why? It shouldn't be that way.

But once people have to pay more out of their own pocket, they are going to be far more careful about who they see. The level of service provided is going to matter. Ease of access is going to matter. Outcomes are going to matter. How about a refund if certain things don't turn out as promised?

And that's where there is going to be tremendous opportunities for startups. To provide technology for patients, and for doctors, hospitals, etc to provide a better level of service. All parties involved will be actively looking for these tools at some point.

Granted there are some regulatory hurdles, and HIPAA was really a poorly thought out piece of legislation, but as the startup community grows, there will be tools made available to navigate these hurdles as well.

drucken• 14 years ago

Perhaps its a compensation or cultural issue with medicine in the UK.

But, as a doctor, changing careers and creating a startup, especially one on the other side of the planet, seems an extreme reaction with extreme risk. Why not go private or even change geographies but remain a doctor while working on this problem on the side?

I say this because, given how well compensated doctors can be, as well as clear and progressive career paths and the strong vocational aspect, the opportunity cost of this change is enormous!

TL;DR. Are there other more significant issues involved?

tomwalker• 14 years ago

in scotland I worked in a hospital and would have to print out blood results on a daily basis for, on average, 20 patients. Some weeks it could easily be 60 patients.

To do this would take about 6 clicks and due to the slow system about 40 seconds I figured out. There would commonly be a queue in the morning to use this computer.

I made a simple script on a pen drive that allowed me to print my bloods for patients I had on a list of 'my patients'

i got a slap on the wrist :(

itmag3• 14 years ago

So you're a doctor AND you know how to code. Very interesting, please do share your story about how that came to be :)

mkelley• 14 years ago

I work for a company in Kentucky that is currently working on developing a system (with cooperation from the Department of Health) that addresses this exact problem. Basically a multi-user application that records all aspects of each Provider's "encounter" with a given patient. A Provider could be a doctor, nurse, lab tech, etc... So at anytime the current provider for a patient has access to all previous "notes" and any other data recorded about the patient as well as who recorded that information. Though I must admit, when I first started on this project I was quite surprised that there really wasn't much out there for public healthcare providers that didn't already do this. Besides Kentucky, there are several other states showing interest as well ... I just thought I'd mention that so nobody thinks, "Oh backwards Kentucky, their doctors run around the hospital barefoot!" Apparently this is a widespread problem in the public healthcare system across the United States as well.

jhaile• 14 years ago

Putting aside income, I think tech/startup jobs are superior to medicine and law because the majority of doctors are simply analyzing symptoms and diagnosing using systems and books written by other people; the majority of lawyers are just interpreting laws written by other people. Whereas tech startups are creating and inventing solutions to problems that can improve the world. Don't get me wrong - I'm glad there are doctors out there (may not say the same for lawyers), but I'd rather be a creator/innovator than someone who is just interpreting things. Too many smart people get stuck in doctor/lawyer jobs for income/status reasons that could be having a bigger impact on the world if they were inventing new ideas and helping create a better world.

goggles99• 14 years ago

I Don't know what hospitals you guys have been in, but my primary health care for the last 12 years has been Sutter in California. The hand-offs have been electronic (custom software, not word docs) for that entire time. The Doctors now carry around a tablet as well to update info about a patient. Before the tablets, every room had a PC for updating info. Maybe Sutter is just a special case, I was surprised at the article and some of the comments here.

Why I quit medicine

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