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Medicine in Denial Paperback – March 31, 2011
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About the Author
Lawrence L. Weed is a physician who, more than 50 years ago, originated influential standards for organizing medical records. He applied these standards (known as the problem-oriented medical record) in designing electronic record systems. He subsequently developed software tools for applying medical knowledge to patient data. His son Lincoln practiced employee benefits law in Washington, D.C. for 26 years and now specializes in health privacy at a consulting firm.
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Michael Warner, D.O., author "Rise of the Patient Advocate - Healthcare in the Digital Age"
Larry Weed famously invented the problem oriented medical record (POMR) back in the sixties. He should be heard in this new read, Medicine in Denial. The Affordable Care Act encourages change in the structure of medical care, much of it coming from the highly subsidized shift towards electronic medical records. This book champions one of those trends; it is a plea for accurate, consistent and standardized medical record.
Weed was born in 1924, graduated from Columbia Medical 1947. He has been prominent in medical education in many teaching positions. I first heard of him at Dartmouth Medical School teaching Family Medicine. He has publications as long as my arm and several books, awards and recognitions. Recently, Weed applied his talents to medical informatics and administrative medicine. Weed founded Problem-Knowledge Coupler Corporation (PKC) of Burlington, VT, a company dedicated to developing the information coupling software and medical information database that the Weeds advocate in their book. Sharecare® of Atlanta, GA, the health and wellness social network acquired PKC June 12, 2012. Dr. Oz, the television host co-founded Sharecare®. Dr Oz plans to make his social technology platform, together with PKC's clinical knowledge management system available to patients and providers to enable clinically informed communications. Weeds version of connecting the vast database of medical knowledge with clinical decision support (CDS) and much of his research may live on in that wellness format.
In the beginning of his book, Doctor Weed and his son Lincoln Weed, an attorney, argue that a lack of complete patient data from the history and physical lead to false assumptions, waste and unnecessary procedures. The Weeds give compelling examples. Here and throughout the book the authors compare the present disorganized medical record keeping and subjective judgment of physicians to the regimented standards of CPAs or airline pilots who follow standard operating procedures. The book is a cry for healthcare reform. Both educationally and clinically Weed would have the standards, the records and decision making dependent on an electronic repository of medical information rather than having the electronic record reflect the judgment and intuition of the provider.
Weed argues that medical information is so vast that it is not possible for the doctor to remember all of the lists associated with sign, symptom and physical finding. The Weeds insist that medical education must change its approach from teaching judgment and diagnostic skills to a more technical training. This would enable the provider to be scrupulously consistent and accurate in developing the clinical database. They further suggest that non-MD providers with this more technical education would be more easily supervised and adherent to standards of procedure devised by experts.
The positive findings in the patient record form a clinical database. This patient data then couples with the vast shared archive of medical terminology matching clinical positives to the criteria for diagnosis in the archive. The result is a differential diagnosis based on matching patterns - much like Google. Two-way communications between the clinical record and medical information, affords both clinical decision support (CDS) for the provider and a graphical representation of the choices for the patient. With the accumulation of sufficient clinical data, the potential for data mining is limitless. It will be a fertile field for research for decades to come. Coupling patient data with the entire electronic database of medical knowledge will presumably mitigate errors and add to patient safety.
The later chapters offer extensive description of the discipline and mechanics of the problem oriented medical record, where better than from the originator.
Although not easy reading, this book certainly encourages thought and speculation about the future of medicine. At times one can tell which Weed is doing the writing. A lawyer often views medical practice with skepticism. The number of wrong diagnoses and medication errors do not improve that view. The success of nurse practitioners in the primary care setting, especially in Europe, may lead to an environment dominated by competent NPs in the US as well.
Weed makes a valid argument in favor of collecting the vast sum of medical knowledge in an open scalable, dynamic and accessible database. To whom that data is accessible, becomes a question for our time. Weed appears to favor individual patient autonomy and care with the vast information base available to the patient for shared decisions. One wonders, however, how widely that information should be shared. An old adage suggests that a doctor who treats himself has a fool for a doctor. With the vast store of medical knowledge available to everyone, one indeed risks having a fool for a doctor.
Midwest Independent Research, educational websites. Improving health, mwir-improvinghealth.blogspot. There are book lists here.