Carer finds her Dog’s care is being more efficiently documented than her Daughters

September 4, 2015

Lynda Thomas We Are MacMillan…for me and us at the Charity delivery is everything because delivery is what makes the difference to people whether they’re living with diabetes or whether they’re living with cancer or other chronic conditions. But I just wanted to use an example of a story, we always talk about Patients and we always use Patients stories, but this is a Patient story with a difference because it starts with a dog, and I guess it illustrates the benefit of this and why we just absolutely have to just get on with this. My story starts with when my dog Charlie, who is a black CockaPoo and absolutely lovely, he woke up one Sunday morning not feeling very well and we had to take him to the Vet and it was a Sunday morning so we rang the Vet and he said I haven’t got a slot today but it’s okay there’s a Vet 3 miles away from where you live you can take Charlie to so we go up to Belsize Park in London which is near to where we live and by the time we got there Charlies data was with the Vet and the Vet was easily able to identify that Charlie had had this problem prior to this, identify what we needed and we left with a prescription and by the time we took Charlie back to our normal Vet a week later the loop had been closed and the data was back to the Vet in Highbury so happy dog and very happy Husband because that’s his pride and joy. 24 hours after Charlie was ill we had to take my daughter Bella, who has a very long history of mental health issues and had just been transferred from Secondary Care back to Primary Care after a 6 month inPatient experience and all we needed was a repeat prescription of the medication that she is on. So we went to the Doctors and the GP didn’t have access to very much information for our daughter and didn’t have the details of what she needed and it’s quite hard for a 15 year old to have to sit there while you talk about her mental health issues and what’s been happening to her and she was very upset and it was really upsetting for her and I thought the timing of those two instances does illustrate we’re doing it for dogs, and I know there’s a difference in Payment methods and everything like that, but if we’re doing it for dogs we’ve just got to do it for humans haven’t we? And if we hold that true and remember that then actually we’ve just got to get on with it

Lynda Thomas, Chief Executive of the Macmillan Cancer Support, talking today on a “Personalised Health and Care 2020: how best to put technology to work for the benefit of patients and citizens” panel on the “Future NHS Stage” at the NHS Innovation Expo in Manchester.

mHealth Insights

Having lived and worked in a Veterinary Surgery long before I went to Medical School the existence of this huge disconnect doesn’t surprise me at all but the confusion that lies around why it’s happening is quite scary when you appreciate that Lynda Thomas is leading a charity focused on the care of Cancer Patients that raises over £100 Million/year.

Taking an informed guess I imagine Charlie was seen at Village Vet (founded by Brendan Robinson this group refer OOH calls from their smaller clinics into their Hospital in Belsize Terrace Hampstead and have been using electronic health records across their practices for at least 10 years) but most Vets in the UK have been using EHRs of some sort for at least a decade (eg. as far back as 1995 I remember if you came into the clinic I worked in but were the registered client of another clinic under different ownership the Vet would automatically have a nurse or receptionist look up the usual Vet in the RVC register and send them a fax to update their records) not because of payment methods but because it’s the right thing to do, because private sector Vets have good Professional Practice guidance and have aligned business agendas that benefit from reciprocal good will.

The NHS isn’t sharing information because the Patient isn’t the customer. Huge financial influences (the UK Veterinary industry never had a $22Billion National Programme for IT focused on documenting Hospital care) have been a life line that has fuelled the growth of tiers of non-Carers who will all have their own vested interests in holding on as tight as they can to their control of Patient data. Common excuses that you’ll hear wheeled out might range from a lack of vision, lame out of date excuses about privacy concerns, lack of time to do anything but try and work harder, a lack of aligned interests, because they’ve always done it that way, etc.

Experience with Veterinary care has helped me develop a good sniff test: if something doesn’t exist in Veterinary Medicine but you find it in Human Medicine you should ask yourself why and you’ll probably find that it’s about smoke and mirrors and has nothing to do with providing care or getting better outcomes for Patients.

Do you think the Veterinary industry has huge Innovation Expos branded by government funded organisations that Vet Clinic Managers travel to and pay hundreds of pounds to attend? Do you think Veterinary administration staff sit about listening to panelists talking about NHS best practices before wandering about in exhibition halls looking at offerings from government funded startup tech vendors?

Seth Godin Change is the point

Related Posts:

The Future of Health Monitoring is here but it’s being used to make animals run faster

How Mobile First Clinical Trials and Ratings will transform the $100B Clinical Research Industry (Laurie Becklund: LA Times: As I lay dying and ‘Treat me like a statistic and save my life’ Medicine X Talk)

Amazon MayDay: Buy a $400 Kindle and get 24/7 video call assistance with 15 sec response time – pay £108 Billion/year for the NHS & you can’t even use the tools of our time.


Health Secretary Jeremy Hunt calls for NHS GPs to provide Patients with mHealth services

September 2, 2015

I also want patients not just to be able to read their medical record on their smartphone but to add to it, whether by recording their own comments or by plugging in their own wearable devices to it

Health Secretary outlines vision for use of technology across NHS at the NHS Innovation Expo.

Interesting to contrast this with the glacial pace of innovation that was outlined in the Royal College of General Practitioner’s 2022 Vision.

If you’re attending the NHS Expo be sure to drop by stand 15 to get a demo of the AskMyGP service that is already enabling Patients to share their medical information from anywhere at anytime with a growing number of leading NHS GPs:

AskMyGP booth at the 2015 NHS Innovation Expo

AskMyGp workflow

Can’t make it to Manchester? Check out this recording I made of AskMyGP’s Harry Longman presenting at the recent Commissioning Show in London on the evidence that supports NHS GP Practices providing online access to Patients and Carers:


New York Academy of Sciences to host mHealth conference focused on The Power of Wearables, Sensors, and Apps to Transform Clinical Trials

September 1, 2015



The New York Academy of Sciences mHealth Conference

About the conference

Mobile technology has become a ubiquitous part of everyday life and the practical utility of these devices for improving human health is only now being realized. Wireless medical sensors, or mobile biosensors, is one such technology that is allowing the vast accumulation of real-time biometric data which may hold invaluable clues for treating some of the most devastating human diseases. From wearable gadgets to sophisticated implantable medical devices, the information retrieved from this mobile technology has the potential to revolutionize how clinical research is conducted and disease therapies are delivered in the coming years.

The New York Academy of Sciences, in collaboration with leading clinical trials software firm Medidata Solutions, will assemble professionals from the fields of science and engineering, analytics, healthcare, business, and government to explore the promise wearable biosensors, along with integrated mobile apps, hold in improving the quality of patient care and clinical outcomes. This one-and-a-half-day conference will focus on groundbreaking device innovation, data optimization and validation, commercial platform integration, as well as clinical implementation and regulation.

Speakers will include:

Pam Baker, Writer/Editor/Analyst, FierceBigData
Brian Bot, Principal Scientist and Community Manager, Sage Bionetworks
Melanie Brickman Stynes, The New York Academy of Sciences
Brooke Grindlinger, The New York Academy of Sciences
John Hinson MD, University of California at San Francisco
Julian Jenkins, GlaxoSmithKline
David C Magnus, Stanford Centre for Biomedical Ethics
Linda Malek, Partner, Moses and Singer LLP
John Mastrototaro, VP Informatics, Medtronic
Veena Misra, Director, North Carolina State University
Bernard Munos, Senior Fellow, FasterCures (a centre of the Milken Institute)
Fiorenzo Omenetto, Prof of Engineering, Tufts University
Aydogan Ozcan, Chancellors Professor, UCLA
Daniel Radiloff, The New York Academy of Sciences
Tomasz Sablinski MD, Transparency Life Sciences
Leonard Sacks MD, US Food & Drug Administration
Christian Stammel, Founder and CEO, Wearable Technologies AG
Ajay Verma MD, VP Experimental Medicine, Biogen Idec
Glen de Vries, Medidata
Pei Wang, Prof of Genetics & Genomics, Icahn School of Medicine at Mount Sinai

Event partners include

Medidata, GTC Bio, Journal of mHealth, Nature Publishing Group and Wearable Technologies AG.

Click here to register.

Related: Watch a video of my talk from the Mobile Clinical Trial Congress on “How Mobile First Clinical Trials & Ratings will transform the $100B Clinical Research Industry”

Check out this comprehensive listing of mHealth events being held around the world in 2015.


Irish Health Service Executive hits Lloyds Pharmacy with allegations of fraud & breach of contract for success of their mHealth service

August 29, 2015



Following the receipt of allegations made by a “whistleblower” and a July inspection the HSE was written to Irelands largest Pharmacy retailer with fraud and breach of contract allegations. The story broke yesterday and has already had wide coverage in Irish media that will be very damaging for the brand as no journalists seem to have the first idea about what’s really at stake here:

RTE News: HSE investigating dispensing fees claimed by LloydsPharmacy group

The Irish Times: HSE investigates Lloyds pharmacy prescription payments. Lloyds denies fraud over boosting income by claiming multiple medical card prescription fees

TheJournal.ie: Ireland’s largest pharmacy group investigated by HSE over ‘irregularities’ in fee claims

Newstalk: Pharmacy has allegedly been encouraging employees to inflate HSE fees by spreading dispensations over several payments

mHealth Insights

Disclosure

As proponents of innovative uses of mobile technology to help improve the quality of Patients and Carers lives I naturally champion innovations like the MyMeds service being brought to market by Healthcare Professionals (and the major retailers they work for who have the resources to invest in this opportunity) as they are very well placed to support the education of Patients and Carers and spend time helping them make the best use of their mobile phones and mobile connected medical devices.

To be very clear we have provided consulting services to Lloyds Pharmacy’s parent company, presented at their annual staff conference and we regularly share the MyMeds service (that is at the centre of these allegations) in talks that we give to Pharmacists as an example of best practice.

Dispensing fees are a very blunt measure of the value that Pharmacists provide and the HSE focus should not just be about decreasing them

Trying to measure the value of Pharmacists by comparing their dispensing fees is daft and outdated. Here’s an experience that I think illustrates this well:

A few years ago I was talking with an Irish Pharmacist about the issue of Patients who don’t take their medications and she shared with me a story about a carer that called into her Pharmacy retail store. An elderly relative had recently passed away and while clearing her home the Carer had noticed loads of medications that had not been opened/taken and they wanted to know what to do with all the medications because they were concerned about the potential harm they might cause if put in with the household refuse. The Pharmacist asked them to bring them in as they’d be grateful to dispose of them safely. Two days later the lady walks in and hands over the counter 3 carrier bags full of unopened and unexpired boxes of medications. I asked the Pharmacist what the value of these medications might’ve been and was told it was in excess of €1,500 to the Irish Taxpayer for the medications alone plus the wasted Doctor appointment and prescribing costs plus of course the Pharmacy dispensing costs.

In the UK a few weeks later I shared this story with a group of NHS Pharmacists and was told that they get exactly the same thing happening. Stunned I asked about how much this Pharmacist felt was being wasted because of the distancing the healthcare service has once the medication is dispensed and the Pharmacist started doing back of the envelope calculations for me. It then dawned on me that the problem in the UK’s NHS is much bigger – the Carer that visited his store wasn’t holding 3 carrier bags they were holding 3 full black refuse sacks!

The HSE needs to start rewarding Pharmacists for work they do above and beyond dispensing

For a more in-depth understanding of this area check out this recording of a “Beyond the Pill” webinar that I participated in with Pfizer’s Global Head of Solution and Product Development and Mark Wilkinson (CEO of NHS Barnsley’s Clinical Commissioning Group) back in 2013.

The MyMeds service is a great example of Pharmacists working to support Patients taking medications. It’s probably not going to be for everyone but it has huge appeal amongst those for whom medication regimes are particularly difficult and where adherence is very low and challenging.

Politicians and Healthcare Ministers claim that they want to drive efforts to improve medication adherence but what signal does it give to the market if the brand that has invested more than €200,000 building a new service gets accused of fraud and breach of contract just because they highlight how out of date HSE reimbursement strategies are?

It’s not wrong to make money from helping the HSE get value for money from the drugs they prescribe

There should be no misunderstanding: the most expensive drugs in Ireland are those that Doctors prescribe, Pharmacists dispense and Patients don’t take.

When a business like Lloyds Pharmacy works out ways to make some money by increasing Patient adherence it’s important to appreciate that they’ll be more than making up for the extra revenue they’re taking from the HSE with the extra savings that the HSE will be getting from the better care that the Patients are receiving.

Patients who are more compliant with their Doctor prescribed medications maintain their good health for longer, can remain working for longer, make fewer demands on their Carers and have much lower long term care costs because they avoid expensive avoidable Hospital admissions and Hospital stays.

It’s the role of the HSE to set robust rules not to flame anyone who follows them.

What I’d like to see happen?

I think Lloyds Pharmacy should seek an immediate retraction of these damaging allegations and the HSE accountants who made them and any directors/investigators who were involved should be required to receive training (eg. the course that we developed for the Healthcare Informatics Society) as the adoption of mHealth is being held back by ignorance that flies in the face of calls by highly respected organisations like the International Diabetes Federation for mHealth to be embedded as a compulsory part of how we provide quality care for Patients with chronic conditions.

What would you like to see the HSE and Lloyds Pharmacy do next?

*** UPDATE Sat 29 Aug 8pm ***

A Doctor I have incredible respect for and who is much smarter and more experienced than I has emailed me on reading this post and suggested that while “controlled dispensing is going to save the NHS millions and is so logical” I shouldn’t be so direct in my support for Lloyds Pharmacy in this instance because they have “focused so much on profit in their encouragement tactics” and may have “bent the rules over claiming because for instance they may be giving Patients a months supply at a time and claiming for each week separately which doesn’t not stop the waste if they don’t take them!“.

I think this comment highlights the fact that we’re in very new ground here and it’s critically important that healthcare payers (the HSE in this instance) not only appreciate that there is an enormous pharma mHealth opportunity (Walgreens have the #1 revenue generating healthcare app generating more than $320 million per month) but that this is something they can positively influence via the terms that they stipulate.

Smart healthcare professionals (in this instance Pharmacists) face immense economic pressures and it’s critical that they’re financially motivated to do the right thing by Payers who are smart and act in the best interests of Patients. While it would be ideal if we had ways to pay Pharmacists for the medications Patients swallowed this isn’t realistically achievable today but that doesn’t mean we shouldn’t take steps towards this goal.

I think the MyMeds service is an important stepping stone forwards because we all know how big an issue poor medication adherence is (>50% of Patients aren’t adherent to their prescribed medications), no one else is making an impact on this and here we have private sector Healthcare Professionals not only doing this but finding an economically viable means (so that it is financially sustainable) of creating an app, marketing it directly to Patients/Carers, helping with the tech issues, etc, etc, so that Patients have reminders (from the device they already carry with them all the time) and are recording their adherence to individually packaged pills.

The MyMeds service has moved the goal posts. Payers shouldn’t be hunting innovators but should focus their efforts on working out ways of penalising all the other Pharmacists who don’t have enough interests (or perhaps don’t care enough?) to offer med reminder/adherence services that (the traction of MyMeds shows) Patients and Carers clearly want.

*** UPDATE Sun 30 Aug 7pm ***

In this RTE Radio 1 interview Darragh O’Loughlin, Pharmacist and CEO of the Irish Pharmacy Union (IPU.ie) while stating clearly that he can’t speak for any actions Lloyds Pharmacy may have taken (as they aren’t an IPU member) or these specific HSE allegations has made some great points when asked in what circumstances it is appropriate for Pharmacists to dispense medications in this phased way and be reimbursed by the HSE for doing this:

There a number of circumstances or situations in which it is absolutely appropriate for a Pharmacist to dispense a Patients medication in these phased weekly doses, for example it could be a case that the Patient has an addiction problem or abuse problems with medication dependency issues so it’s appropriate that they would only be given small quantities at a time. There can be occasions when there is a risk of diversion of medication for example anxiety or sleeping pills that might be legitimately prescribed for one Patient but are being diverted then into the illegitimate market and in order to prevent that Doctors or Pharmacists might decide only to give them out in small quantities. But the major issue is with the increasing complexity of medication regimes and the increasing number of elderly Patients and the people just simply get a bit confused about their medication or they’re not taking their medications properly as prescribed – they could be missing doses or doubling up on doses and this can come to the attention of the Pharmacist or the Patients Carer and in order to prevent that from happening the Pharmacist will often say we will dispense that medication in these weekly trays done out by day – intact by morning, mid day, afternoon and evening dose so that it’s easy to see that the Patient has taken each dose at the appropriate time… …it’s a facility that’s there for Pharmacists to provide a service to assist Patients in taking their own medication appropriately or to prevent abuse or misuse of medication, or simply because medication has a short shelf life such as with children’s antibiotics that last for a week so fi a child needs to take it for a number of weeks they have to return each week for a fresh course… …the HSE has all of the dispensing and fee information on every Pharmacy in the country and as a taxpayer I would expect them to engage in an ongoing audit of that just to ensure that money is being expended appropriately but your question was would it ever be appropriate to dispense a months medication in one go and then to claim for having dispensed it weekly – if I understand your question? – and in that case where the Pharmacist is doing out weekly trays which set out dosing on a daily basis to our Patients it’s almost a bit of a red herring as whether four trays are handed over to the Carer at the same time or they are handed over every fortnight or every week because what is being put in place is the facility to monitor Patients taking their medications on a daily and weekly basis to ensure that they’re taking it properly. So Pharmacists will frequently give those trays out on a weekly basis to a Patient who comes in so that they can have that weekly contact and see that this individual is still taking their medication but there could in other circumstances be a Carer who says I want to take responsibility for these trays and I’m going to give them over to my mum or my dad – or whoever it might be – on a weekly basis but I don’t want to visit the Pharmacy every week because I don’t have time and in that case it’s reasonable for the Pharmacist to give the four trays over and say this is week 1, week 2, week 3, week 4 and this is how it works…

*** UPDATE Mon 31 Aug 11.40am ***

Interesting to note that today the HSE is promoting Overdose Awareness Day:

Screen Shot 2015-08-31 at 11.35.05

The awareness video the HSE has produced is also very revealing:

(5min45sec Daniel) …my experience with overdose would be I was in prison for 9 months and the very day I got out I went to my Doctor and without seeing him he gave me fifty Xanaxs (Alprazolam – a Benzodiazepine medication). I took six of them and couldn’t remember anything after that (but) I took heroine on top of that and I was took back to the hospital…

The Health Research Board has claimed that in 2012 there were twice as many killed from overdoses than killed in road traffic accidents and that there has been a “considerable” increase in the number of deaths involving prescription medication eg. in more than half of the overdose deaths last year there was more than one drug used and after alcohol the most commonly found other drugs used were diazepam, methadone and anti-depressant medications.

*** UPDATE Tuesday 1 September 11am ***

A reader contacted me with the suggestion that it’s not clear what the “MyMed” service entails. Here’s a link to more info on the exclusive tablet pack into which Lloyds Pharmacy dispense medications:

Screen Shot 2015-09-01 at 10.58.21

For more detailed information check out this PDF of the leaflet that is being distributed in retail stores for Patients and Carers to consider:

Screen Shot 2015-09-01 at 10.38.40.


Software has changed the world, but here’s why it hasn’t improved healthcare

August 26, 2015



Software hasn't improved healthcare

This Quartz article by Akshat Rathi featuring comments from “The technoptimist doctorBob Wachter, a physician and professor of medicine at the University of California San Francisco and author of The Digital Doctor, highlights some common misconceptions that I thought might be worth attempting to dispel.

mHealth Insights

“The computer age promised great transformations but so far it’s done little to transform healthcare”

Perhaps commentators just don’t realise software is used the world over to coordinate emergency services and train the next generation of Doctors? If you’re undecided spend some time trying to imagine how healthcare services would operate if everyone didn’t have connectivity in their pockets. If that fails try and forfeit your mobile and internet use for a week and see how your attitude changes (if you’re a Doctor thinking about doing this check with your medicolegal insurer first!).

please-be-patient-im-still-practising

“You still need to visit your doctor for most ailments”

This isn’t always the case eg. for Patients who are very wealthy and have expensive private insurance, NHS Patients who have smart switched on caring GPs and Surgeons or anyone who can afford £35 out of their own pocket.

“The use of technology was supposed to help increase face time with a doctor, but the exact opposite has happened. And all the data gathering hasn’t really brought radical new treatments”

Malcolm Gladwell has brilliantly explained how in the cause of efficiency the sickcare industry has disrupted the very thing the Patient really wants. Perhaps it’s the obsessive focus on providing ‘FaceTime with a Doctor’ that precludes a lot of healthcare professionals from appreciating the advances technology has brought to medicine. To have any hope of appreciating the opportunity for tech to help improve healthcare we need to stop thinking that the product we choose to produce is the office visit.

If you’re not getting this take the time to watch the following video of a talk given by Bruce Elliott at the Margaret Rickson Memorial Conference in June that shares the experiences of a diabetic Patient. It will leave you in no doubt that technology has already radically reduced the need for Patients to spend their valuable time with Doctors in clinics:

The use of apps by Diabetics can be very confusing but clinicians need to be on top of this as many Patients already see their mobile as an intrinsic part of their care and Carers are increasingly prepared to hack the healthcare services that they’re being prescribed because they realise that they’re hopelessly out dated.

“Bob Wachter, a physician and professor of medicine at the University of California, San Francisco, has championed the use of technology in hospital care. And, yet, he has seen time and again that the problem lies mainly in the implementation of technology”

Spot on. I’ve felt that just 10% of IT budgets should go on the IT tech (software and hardware) and 90% should be spent on training & development and this is one of the big factors that is behind why mHealth is so transformational eg. we can radically shift spend when staff can leverage devices that they already own and know how to use.

“The case of a patient, who received a 39-fold overdose of an antibiotic despite his hospital’s state-of-the-art healthcare software, spurred Wachter to look more critically at why technology continues to fail patients”

I think it’s important to appreciate that the hospital wasn’t using software that was anywhere near “state-of-the-art”. Most US Hospital software is designed primarily to enable the billing of transactions and the Clinician/Patient interaction piece is just an afterthought that is sold via dinner/beer buying sales teams to Doctors who typically have no relevant IT training or capacity to evaluate technology.

If you doubt that these software design priorities are in place ask yourself this one simple question: do you think the Hospital software failed to bill for the 39 fold dose of antibiotic that was being delivered to this unfortunate Patient?

Then you come in and say, “I have this new tool that will change your life in five or ten years for the better, but until then it will make your life worse. And in that period, you will have to change how you work: allocate time differently, alter workflow, add more layers to the decision-making process, etc.” Doctors are not going to willingly accept ways in which bureaucracy can more easily become intrusive. It’s unlike how things work when you download a new app. The difference is that getting used to an app will only take a week and life will be better after. For doctors, that waiting period right now is five years, and in that period they are worried that using these tools they might actually end up hurting people

This makes a really good point about the importance of expectations and the impact that end user rating systems have on driving software quality. It’s key that we appreciate that the reason that new app you downloaded is going to work is because before you downloaded it you could see it’s description together with how others rated it’s use and because there is a mechanism for you to publicly share feedback on your experience.

These have important knock on effects because firstly you probably won’t even consider downloading an app that is rated as useless/a waste of time and it also ensures that if you uncover things the app developer/brand can get direct feedback and the advice on how to rectify the issue(s).

This is why BYOD strategies are working so well in getting traction amongst healthcare providers even in comparison to the competitive rival offerings provided by healthcare organisations. Here are a couple of examples of how we see this happening here in Ireland:

> the vast majority of Doctors in Ireland use free* (* read advertiser funded Gmail/Hotmail/yahoo/etc) email accounts to send and receive clinical Patient information in preference to the Health Service Executive funded Healthmail.ie service even though the government provisioned service provides security/privacy assurances and there are data protection act directives that users of the ‘free’ accounts are being told they are in breach of.

> Practically all implanted cardiac devices in Ireland are sold without connected services even though many manufacturers offer Clinicians/Hospitals comprehensive tech solutions that could support this. Meanwhile the same Cardiologists who are declining to opt for these connected services are prescribing Alivecor ECG cases to Patients who have smartphones so that they can provide a more user friendly DIY style alternative that drives Patient participation.

> Most glucometers in use by diabetics in Ireland have never had the data they collect downloaded and while most Endocrinologists are encouraging Patients to go on app stores and use apps the standard practice for review of Blood Glucose levels remains the same as it was pre-smartphones eg. fanning your face with a Patients paper diary.

“Because the UK’s National Health Service is government-run, the pre-conditions for digitization were better in the UK than in the US. Theoretically, all the hospitals want to be on the same platform, want to be able to talk each other, and have a powerful incentive to keep care as inexpensive as possible”

This is a common misconception about NHS Hospitals. Theoretically and practically we can see they have self interests that have prevented them from choosing uniformity. Expecting Hospitals to want to keep care as inexpensive as possible maybe exists in a fairytale but in reality it’s a lot more complex and NHS Hospitals spend fortunes on expensive recruitment agencies (wages make up a huge chunk of hospital budgets), don’t have national contracts for procurement, etc, etc.

“When you ask people in the know in the UK about why Connecting for Health [the UK program for digitization] failed, they say it was because of a fundamental misunderstanding of the complexity. The person in charge of the program was a master of logistics and procurement, and he believed that this whole thing could be run centrally. It was like procuring arms and ammunitions for the military—he didn’t want each base to worry about their own supply and wanted to buy at scale. There might have been the need for some boots on the ground, but most of the implementation was to be done centrally”

Many people think I’m in the know and to me this doesn’t explain the failure. It wasn’t that they misunderstood the complexity it was that they failed to include Patients, evidence can be found for this from the NPfIT focus on Hospitals instead of Primary Care (the GP/Patient level is where the biggest communication challenge s exist). The runaway adoption success of KPs service that prioritised providing the Clinician engagement that Patients wanted should provide proof that this was the case.

“That is why a hospital like ours has a massive IT staff. You’d say that you bought a software application, and you should be able to use it out of the box. But that’s not how it works. You need all that staff to localize it for the needs of our hospital. They also need to setup policies and even sell it to the technophobes”

This is an outlook that I see so many Hospitals suffering from because they haven’t prioritised IT and they lack the vision and desire to collaborate.

I continue to be amazed that so many Healthcare IT initiatives are led by well paid professionals who think that Healthcare IT training is little more than ‘selling’ something to technophobes.

“The aviation industry today is remarkably safe, and it wasn’t always the case. So it seemed logical for the healthcare industry to look to aviation industry for lessons. A lot of things they’ve done, such as the standardization of the cockpit, the use of simulation to train pilots, and the enforcement of safety standards, are great examples. But whenever you speak to a physician about this example, I can tell you that it annoys them. And that’s because what aviation has to do is easier than what doctors need to do”

I’ve seen this happening before in a lecture and the conclusion I came to was very different: the best teachers may make it look easy but a much greater level of understanding is required to be able to properly teach something than most appreciate. The Doctors I saw were annoyed because they weren’t inspired enough to even begin to appreciate the difficulties faced by the aviation industry and they probably realised the salesman delivering the thinly veiled pitch had little/no idea about the complexity of the challenges that aviation or medicine faced/faces.

If you get someone who understands the complexity of aviation and medicine – smart Doctors I know of who also have piloting experience would include Dr Richard Sills, Dr Daniel Kraft or Dr Chris Bickford – the educational opportunity is golden.

What thoughts did you have on reading the article?


The future of Health Monitoring is already here but we just use it to make animals run faster

August 22, 2015



Aidan OBrien

Unfortunately most of the monitoring applications I’ve been involved with over the last 30 years (I was using wearable sensors to monitor racing animals long before I went to medical school) remain largely confidential but I think this Irish Times insider tour of Aidan O’Brien’s world beating Tipperary stud farm and training grounds reveals interesting insights worth sharing with healthcare providers who still think remote monitoring just means they have to carry a pager.

Joseph, her eldest son and Ballydoyle’s lead jockey, strolls past. At six feet tall, he doesn’t look like a typical rider. “I was told all jockeys were tiny,” I say. He’s clearly heard this before. “Who told you that?” he says with a shake of his head. Truth is, jockeys don’t have to be small, they just have to be light. And a six footer keeping his weight under nine stone takes a whole lot more discipline than it does if they’re eight inches shorter

Building a diet app/service? Follow the world’s top jockeys on Twitter and study the discipline techniques they’re using.

Today FM’s breakfast show booms from speakers hanging from the barn walls. I ask Annemarie if the jockeys like the radio. “It’s not for them, it’s for the horses. When they hear it in the morning, they know it’s time to work. Then at around 12.30pm they’ll have lunch and the radio goes off and they’ll know it’s time to rest”

Contrast this with the healthcare industry that let’s companies with vested interests publish scientific papers trying to prove the value of music/sleep/lighting, where Hospital wards are lit with fluorescent tubes and ring with alarm bells and where insurance companies refuse to even cover the costs of hearing aids.

In silence, we watch his horses circling. “They’re really relaxed right now,” he says. “But if something small changes, even a coat being hung in a different place, that can unsettle them.”

Visit any operating room, imaging suite or Patient ward and count the completely unnecessary distractions that no one is except the Patient is bothered about enough to have applied thoughtful design.

O’Brien stands in the centre of the barn, like the conductor of an equine orchestra, staring intently at his passing charges. He’s gauging their moods, making sure everything’s okay. He’s joined by Tom Curtis, who keeps a close eye on the horses’ vital signs using heart rate monitors strapped to their chests. He’s checking heart consistency and recovery rates. He tells me a horse’s heart can reach 220 beats per minute when they’re at full tilt, falling to just 30 at rest. But the monitors don’t just tell Curtis how fast a horse’s heart is beating. They tell him what they’re thinking too.

Clearly they should be using AlivecorVet ECGs as then they won’t have the distraction of the straps (not only will these discrete devices give them more than just rate monitoring but they are so small and accurate they can be concealed within a sewn fold in a saddle cloth) but contrast this with your average Hospital ward where no one has any idea about any of the Patients heart rates (or the rates of the stressed out staff who are ticking boxes on clipboards to make it look like there are quality controls and pulling their backs lugging about bundles of paper folders containing reams of data they haven’t a hope of processing).

My face tells him what I’m thinking. Before I can verbalise my question, he answers it. Horses are so sensitive to their surroundings and Curtis so tuned in to their sensitivities that if a horse is paired with a new jockey or is having a bad day for some other reason, the subtle shift in its heart rhythms will alert him

I wonder if it might just be this incredible sensitivity that’s holding back the adoption of tech like that you see being used in Apple TV commercials from becoming adopted for use by the racing industry regulators? What chance would illegal drug users have of fixing racing results if horses were required to wear a continuous ECG monitor for the 24hrs before they were allowed to race?

Riding parallel, 10ft from to the track, we quickly reach 60km an hour. He points to the lead horse. “He’s lazy,” he says. But we’re going at a fair old clip, I say. “Ah but look at his ears. They’re straight up. If he was pushing himself they’d be flat back

Check the screen on the iPad and you’ll see his ECG also looks very different ;)

Travelling so close to racehorses as they’re put through their paces is exhilarating. They’re magnificent. As the session reaches its climax both horses – even the “lazy” fella – do their best to finish first. Their intense concentration is matched by the determination of the jockeys. O’Brien says nothing. He just drives alongside, watching every muscle and sinew move. All sessions are taped and jockeys’ thoughts recorded as they dismount. The attention to detail is extraordinary

Healthcare Journalists get breathless when a surgeon writes about using age old checklists so one wonders what it will take before it becomes standard practice for Surgeons to document their post op feelings like Ballydoyle Jockeys document their rides?

Aiden O’Brien should be lecturing at theThe Royal College of Surgeons!

O’Brien discusses horse psychology. “When you think something, they feel it. They’re remarkable. They feel everything. You can see the disappointment in their faces when they lose or when something’s not right. You’d pull a horse out of a race if his mood wasn’t right.”

Without the ability to talk it’s impossible for Veterinarians to do their work without first appreciating the personal context of their Patients but imagine if a horse could talk: in all seriousness how long do you think it would be before we interrupted them?

We pass a colt having his morning shower. “See how happy he is,” O’Brien says with a smile. “You can tell straight away if a horse is feeling down. He’s not feeling down

As we’ve seen with Olympic medal winning teams, data acquired through the use of low cost highly accurate mHealth monitoring tech you can buy in an Apple Store is giving data scientists innate reading skills close/equivalent to those of the world’s best trainers who have committed their lives to making emotional connections. These are not binary options – can you imagine the potential to improve care processes as we can increasingly mix the two skill sets?

We pass the horses and jockeys we met earlier in the barn. They’re lounging in the sun, some rolling around like puppies with their legs in the air – the horses not the jockeys, the jockeys are way too focussed on watching their charges for such merriment. “They’re relieving some stress,” O’Brien says. He points to Gleneagles. He’s the only one with his bridle removed. “He likes it taken off as soon as he’s finished his work. It was Joseph who realised that. None of the other horses want their bridle off. It’s strange but that’s the way he likes it. If we thought he liked being put in that tree over there, we’d do it – whatever they want, they get

This is also why you’ll see gorgeous little ponies flying around the world in incredibly expensive luxury suites on Jumbo Jets as companions for race horses. Compare this to how humans suffer with rigid prescribed visiting hour rules when being ‘cared’ for in our hospitals…

Annemarie takes me to the horse spa. The treadmill and swimming pool are here, as well as a cold salt water tank. There’s a sauna and a solarium with heated lamps. Recent additions include a vibrating plate to get horses’ legs warmed ahead of their go on a new underwater treadmill. “When you’re walking in water, you have to walk properly,” says Eamonn Kavanagh, who travelled from Ireland to Germany and then Kentucky on behalf of O’Brien to assess options before having a bespoke piece of kit built. “You can’t be slacking off in the water. The horses love it. And it is of great benefit, both mentally and physically. It is a great low impact, high resistance work out,” he says

Compare this to the rehab facilities in your typical hospital (which often amount to little more than an afterthought) and get in touch if you’d like to get a look at the real time biofeedback controlled aqua treadmill we helped to develop:

Alivecor on Racing Greyhound

Annemarie walks me back to the house. The family have been here for 20 years. Does she see herself here 20 years from now? “We would like to think so, but who knows? No one is indispensable. It’s like any other sport. You’re only as good as what you’re doing this minute

This is how a real data scientist approaches the future. This is precisely why I think we need to have healthcare interactions comprehensively documented (in ways similar to how the Horse Racing industry has comprehensively documented and made available all results and histories) because once we have this we can start paying attention and stop fuelling the exponential growth of bad medicine.

Next time you’re watching the races check out the transport lorries with the bubbles on the top (they’re satellites used to add data comms in remote/rural areas) and compare that to your local hospital with it’s acres of 3G/Wifi network dead spots.

Want to learn more? Click here to find out how you can get involved in the mHealth Tour we’ll be hosting to coincide with the huge WebSummit event in Dublin (which will for 2015 also feature Data Science & Sport Summits).


“The New Child Abuse Panic” by Maxine Eichner in the New York Times

August 13, 2015

NYTimes The New Child Abuse Panic

Some fascinating insights are shared in this NewYork Times opinion piece describing a disturbing challenge facing some Parents as they attempt to take an active role in healthcare decision making for their sick children.

Maxine Eichner, author of “The Supportive State: Families, Government, and America’s Political Ideals” and Professor of law at the University of North Carolina, feels ‘lucky’ to have avoided charges of medical child abuse following an 8 year search for answers to her daughters mysterious illness and together with the 186 comments it highlights for me some very important ways in which undocumented healthcare encounters are failing Patients and Carers.

mHealth Insights:

​”​Few things are tougher for a parent than dealing with a child’s serious medical condition, particularly if it is complicated and hard to diagnose. The parent has to make hard choices about treatment, navigating conflicting advice from doctors or even rejecting one doctor’s opinion and seeking another​. ​Recently, the situation of these parents has gotten even harder. Some doctors and hospitals have begun to level a radical new charge — “medical child abuse” — against parents who, they say, get unnecessary or excessive treatment for their kids. That this care is usually ordered by other doctors hasn’t protected parents from these loaded accusation​s​

This for me really highlights the crux of the problem. Patients are all too often rejecting what they consider to be ‘one doctor’s opinion‘ when they shouldn’t ever be in that position except for in the instance of incredibly rare diseases.​ We live in a time when it’s possible for a boy on the street of Kolkata
to share a SMS (linking to quality content and videos) with the president of the USA we need to be providing Patients with not just a worded opinion but something that’s backed up with written information that will support Patients and Carers if they wish to learn more about the reasoning and opinions that have been considered in deciding on this course of action.

​”Although most of these cases have nothing to do with real child abuse, credulous child welfare officials have too often supported the doctors, threatened parents with loss of custody, and even removed kids from their homes — simply because the parents disagreed with the doctor’s plan of care​

I think we need to make it clear that when we know that somewhere between 40-80% of information provided to Patients by Healthcare Practitioners is forgotten immediately there may be a distinct difference between a) a Doctor’s plan of care and b) what Parents recall of a Doctor’s plan of care​. I think we’ve also got to be clear that Doctors aren’t infalliable and will particularly when there are huge pressures and demands on their time failing to mention things that they should of and would have in the ideal consultation.

​”​Perhaps the most notorious such case is that of Justina Pelletier, a teenager who was being treated for mitochondrial disease, or “mito,” a rare metabolic disorder that interferes with energy production. On the advice of a metabolic geneticist at Tufts Medical Center who was treating her, she was admitted in 2013 to Boston Children’s Hospital, so that she could see her longtime gastroenterologist, who had recently moved there. Without consulting the girl’s doctor at Tufts, Boston Children’s concluded that the girl’s problem was not mito, but largely psychiatric, according to The Boston Globe.​ ​When her parents disagreed and sought to transfer her back to Tufts, Boston Children’s called child protection, asserting that the parents were harmfully interfering in her care. Although the Tufts geneticist supported the mito diagnosis, a juvenile court judge deferred to Boston Children’s assessment, and Justina’s parents lost custody. After more than 16 months in state custody, much of it spent in a locked psychiatric ward, Justina was finally returned to her parents — still in a wheelchair, still sick​

For how much longer can we go on treating teenage Patients and their families with less respect than a statistic?

Imagine if we could​ ​exhaustively document​ the care experience​ right down to every single symptom or concern expressed by this teenage Patient or noticed by ​their​ Carer/Parents. Instead of scratching heads and ordering tests we ​could use draw connections and gather insights from this data to ​start looking for instances where similar symptoms are being noticed in other Patients so that others can benefit from earlier detection of signs and more focused evidence and experience based treatments.​ Isn’t this how ​data insight based​ companies ​like Apple, Google and Facebook ​treat data​​?

​Her symptoms began when she was 10 and had her first migraine. The headaches became so frequent, nauseating and painful that she missed most school for two years. Eventually, at 13, she received a diagnosis of postural orthostatic tachycardia syndrome, an autonomic nervous system disorder​. ​We learned how to deal with this condition, but when our daughter was 15, her health deteriorated once again. She started to fall — first once a day, then five times, then 20 times a day. The dizziness, fatigue and nausea worsened. When her neurologist refused to believe that the falls were caused by anything besides faintness from the nervous system disorder — though we could see that she was fully conscious and that her legs weren’t working properly during the falls — we sought out other experts. None could explain the falls. Meanwhile, our daughter spent two years using a wheelchair to go all but the shortest of distances​. Many doctors suggested that she was exaggerating or even faking her symptoms. A few thought her symptoms resulted from psychological factors like stress. Others surmised that the problem was me: Perhaps because I had migraines when I was younger, I was overly sensitive to her pain. Or perhaps my refusal to accept the doctors’ conclusions was preventing my daughter from dealing with her psychological issues​. ​When she was 18, our daughter learned that some patients with her nervous-system disorder had been diagnosed with mitochondrial disease, which would also explain her intermittent leg weakness. We consulted a mito expert, and almost wept with relief when she believed our account of our daughter’s symptoms. Tests confirmed that our daughter had mito. With luck and a team of exceptional doctors, she managed to get her life back. She recently finished her third year of college. Her wheelchair gathers dust in our basement

It’s time the healthcare industry adopted “May I make better mistakes tomorrow” as it’s mantra. Today you can be sure that there is a​​nother Patient seeing a Doctor who is sat in front of a multi billion dollar Electronic Disease Record that is ​struggling to draw connections from symptoms that are similar to those that were experienced by​​ Maxine Eichner​’s teenage daughter. Why aren’t we paying attention and providing Clinicians with decision aid support tools to help them make sense of data?

​”As I’ve researched medical child abuse over the past year, several advocacy and support groups for patients with rare diseases told me they had seen an alarming rise in medical child abuse charges: MitoAction (which supports patients with mito); the American Partnership for Eosinophilic Disorders (disorders relating to white blood cells); the Ehlers-Danlos National Foundation (a rare disorder of the connective tissues); and Dysautonomia International (autonomic nervous system disorders). Through these groups, I’ve surveyed 95 parents who have been accused, in 30 states​

Imagine the potential for these medical child abuse advocacy and support groups to call for Parents to get access to clinically validated medical history taking questionnaires​? The saying “If it isn’t documented it hasn’t been done” would have huge meaning to these Parents as they struggle at incredibly difficult times to recollect when and with whom they shared what information against a backdrop of consultations where they’re being interrupted before being given the opportunity to share their story.

​”​Dr. Frances D. Kendall, the geneticist in Atlanta who diagnosed my daughter’s mitochondrial disease, told me that she has seen a rising number of cases in which the parents of children with mito had been wrongly charged. Dr. Mark S. Korson, the geneticist who treated Justina Pelletier at Tufts, also said that such charges have snowballed in recent years.​ ​Most states lump “medical child abuse” into general child abuse or neglect statistics, and can’t break out separate numbers. Michigan is an exception. Its figures show that, on average, 51 charges of medical abuse have been made against caretakers each year between 2010 and 2013. Extrapolating this to the national population would mean more than 1,600 charges each year​

The families of more than 1600 children are facing ‘he said she said’ arguments while experiencing some of the most unimaginably tough times for which they have no experience or training to call upon. I wonder how many medical child abuse cases involve issues that have arisen from Parents conducting internet research and trying to share this with their Doctors?

​”Sadly, while knowledge of Munchausen traveled across the Atlantic, skepticism about it did not. Starting in the mid-1990s, two doctors — Dr. Carole Jenny, a pediatrician specializing in child abuse, and her husband, Dr. Thomas A. Roesler, a psychiatrist — proposed that Munchausen’s taint could be avoided by reconceptualizing the condition. Doctors, they said, shouldn’t focus on the parent’s mental state (as in Munchausen) but, instead, simply determine whether the child had received unnecessary and harmful, or potentially harmful, care at the behest of a parent. They defined “potentially harmful” to include any unnecessary medicine or diagnostic test that could have harmful side effects, even if the child wasn’t actually harmed. Such care, they argued, should be labeled medical child abuse, and treated like any other kind of child abuse​

I wonder why we don’t see this legislation being used to bring child abuse charges to website owners and advertisers who peddle misinformation that leads to Parents choosing potentially harmful and unnecessary medicines/tests??

​”Dr. Richard G. Boles, a mitochondrial disease specialist who has worked on some 100 cases involving suspected medical child abuse, said that only about five fit the classic Munchausen situation and should be considered abuse. Of the rest, he says, about two-thirds involved a demanding mother who got on a doctor’s nerves; the remainder involved a parent who was too anxious in dealing with doctors who couldn’t give adequate answers

Once again it seems “Little Miss A-type personalities” are finding it hard to get on with a healthcare service that’s still focused exclusively on providing office visits.

​”​Compounding the problems with the overly broad definition of medical child abuse is the considerable misinformation spread by its proponents. In 2013, a governor’s task force in Michigan stated that “many cases of Medical Child Abuse go undetected because caregivers are skilled at deceiving the medical community.” No hard evidence, however, suggests that such parents are anything but rare. Medical child abuse is far more likely overcharged than undercharged​

The other big benefit of automatically documenting care interactions is that not only can innocent parents be protected but undetected child abusers can’t as easily hide.​

​”​The task force identified these warning signs of medical child abuse: a “highly attentive parent” who is “unusually reluctant to leave his/her child’s side”; a parent who “demands second and third opinions”; a parent who “is not relieved or reassured when presented with negative test results and resists having the child discharged from the hospital”; and a parent who has “unusually detailed medical knowledge.” These warning signs accurately describe many, if not most, loving parents of medically fragile children​”

​This ​is precisely why you can’t let warning signs be triggered by such broad generalisations. It’s not enough to just record symptoms in a basic paint by numbers style, we need to use questionnaires that can record the reasons why Parents are presenting information so that we can connect with them and understand why they are doing what they do in these very difficult times.

There are Psychologists who have first hand experience with parents that have been proven to have Munchausen Syndrome by proxy and there are very distinctive personalities at play that could be specifically looked for. Rejection of the questionnaires outright might even act as a red flag event that would help identify genuine cases of child medical abuse.

“A spokeswoman for Cook Children’s said that she could not discuss the case because of confidentiality rules, but added that the hospital was “morally and ethically obligated to protect children” and would “always err on the side of caution for that child

How much better would these situations be if Childrens Hospitals erred on the side of early detection and prevention of unnecessary medical child abuse investigations?

​”Government should not get involved when doctors disagree about a diagnosis or course of treatment, the doctors have full knowledge of the child’s medical record, and a parent chooses one doctor’s opinion over another’s. It should intervene only when there is evidence that a parent has intentionally provided significant misinformation to physicians, fabricated elements of the medical history or induced medical symptoms. Parents should always be allowed to seek second (and third) opinions​

I think this is a very sensible suggestion but it leaves open the how? Without providing Patients with access to medical history taking questionnaires the act of intentionally provideing​​ significant misinformation to physicians​ and fabricating elements of the medical history will be a whitewash as the suspicious/accusing physician is the individual who is responsible for entering the Patient information/symptoms into the EHR.

​”​We must protect children from the rare disturbed parent. But medical child abuse, as it has been understood, is far too big and blunt an instrument to accomplish this purpose. It has harmed too many genuinely sick kids, and made life hell for too many loving parents. It is time to end the medical abuse panic​

​How? ​​

​”​It reads a bit like trying to make something from nothing. The numbers are meaningless without something in the denominator. Is this just a .001% phenomenon happening mostly to the middle class to 1%? And how does it compare to the middle class and below, for whom getting into a doctor, let alone shopping around the country to specialists has never been an option?​”

​I too would love to see more data on this but we’re not going to be getting this if we’re bundling all child abuse cases together and the investigations are so drawn out and based on recollections of personal encounters that happen at times of enormous stress.

​There are some great comments (186 already) eg. this one from a Doctor who makes a great point about the need to accept some uncertainty:

​”​I agree that physicians make mistakes. We are not omniscient. In my career as a physician I have found that the majority of doctors are good people and likely not getting rich in this industry. If a patient or family has the suspicion that money is the motivation for care, you should find another physician.​ ​That being said, I would be VERY cautious about the industry of over-diagnosis. There are some docs who make a whole lot of money making sure a patient has a diagnosis.​ ​As a patient, and consumer, be very careful about doctors who accept only cash per appointment. Be very careful about doctors who may not have a stellar reputation (this may be difficult, but honest physicians in your community ought to be able to assist you). Be very careful about doctors who make the frequent ‘mitochondrial disease’ diagnosis…there is a possibility they are not correct either​”

Another comment reminds us of why the history of how aviation safety ​evolved should be taught in every medical school:

​Doctors are humans, they make mistakes, some of them are biased or driven by ideology or profit. Ideally, we should have a systems where those problems are corrected and fixed before they have consequences. But we don’t have such a system. Instead, we have defensive medicine and sometimes antagonistic medicine, where patients are put against doctors and vice versa. We need a complete overhaul of our system. But I think it should start with the doctors themselves questioning and looking for solutions​”

Some great thoughts on the need for Doctors to be trained on the opportunity to use the tools of our time with their Patients:

Just one slightly tangential comment: Doctors need to come to terms with the internet and the unalterable fact that today’s medical consumers do, and most certainly should, avail themselves of the medical resources there. There seems to be something of a consensus that any independent research by patients is an annoying, ill-advised usurpation of the physician’s role. We can all understand that self-misdiagnoses can be problematic, but we also all know from personal experience that we catch important things that doctors don’t, get good advice from reputable medical sites, and are unlikely to risk the entirety of our input to an overburdened, highly fallible and distracted doctor (or NP) who has all of 15 minutes to hear our concerns. We have lots of time to attend to our own predicament and a lot of information that physicians have neither the time nor inclination to gather from us. Informed consumers should not be intimidated by arrogant doctors, whose track record is unfortunately not particularly impressive. Physicians should respect and work in harmony with intelligently informed patients

Katherine Owsiany reminds us how urgently we need to update medical teaching so that Patients feel comfortable sharing with their Doctors information that is influencing the decisions they are making:

(Katherine Owsiany, Charlottesville, VA July 12, 2015) When I got to medical school, I was really surprised by the way the medical community viewed parents who disagree with doctors. Too many physicians are still indignant when dealing with families that disagree or don’t “comply.” Like many schools across the country, we go over this issue in ethics sessions and read the book “The Spirit Catches You and You Fall Down,” which addresses this theme. However, there is a definite population of not only doctors, but people in the health care community in general, that still hold erroneous beliefs about the ability of the non-medical community to make decisions about their own lives. It is true that doctors are obligated to report suspected child abuse, but too many people take that as an obligation to suspect abuse even when evidence is tenuous at best. More physicians need to recognize that it is part of the job to communicate effectively with patients’ families before going to the authorities and that it is in the best interest of everybody to seek second opinions on complex patients. The doctor’s role is to serve the patient, not control the patient. This article is important for doctors to read and remember the patient’s perspective

Lorrie Beauchamp reminds me how much I hope we see algorithms replace lawyers before they try to substitute for Doctors:

“​(Lorrie Beauchamp Montreal, Canada July 12, 2015) As a former medical writer who is familiar with the staggering amount of medical knowledge that the average doctor needs to learn and KEEP learning, I can attest to the fact that many physicians become overly defensive when they can’t find a diagnosis. Egos are alive and well in this chosen profession. Unfortunately, it’s also the ego that rules in the legal system, and I can’t help but wonder how much of this is the result of aggressive lawyers eager to either set a precedent or leverage a trending one. Doctors don’t know everything, lawyers want to win, and parents with sick children should not have to deal with this…​

What thoughts did the article/comments leave you with?


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