MD Enshittification

[erronis]

https://sciencebasedmedicine.org/md-enshittification/
Mark Crislip

An interesting view on what the author believes is the negative impacts of AI and much of the new technology used in the medical profession. Basically a decrease in the skills and time that a provider should have to apply to the patients.

Enshittification, also known as crapification and platform decay, is a process in which two-sided online products and services decline in quality over time.

As some of you may be aware, I was an Infectious Disease (ID) physician for almost 40 years, retiring 3 years ago. My practice was almost entirely concerned with taking care of patients in several acute care hospitals. So everyone whose care I was involved in was sick. ID is unusual in that most of my consults were the odd and usual, infections and diseases, that others could not manage. I once counted 1300 or so pathogens I needed to know for work. Infections can also involve any organ system. It is said the ID doctor has to be the second-best cardiologist, second-best pulmonologist, etc. There was a lot of variety in the cases I saw. If you want an idea of the scope of ID, check out the Puswhisperer, 1300 blog entries I wrote for Medscape. Available on Amazon.

What follows is how I did things, and I do not know how my routine maps on to any other physician.

So I get a consult. Usually a page to a phone number. Here I was kind of a butthead, but I usually asked if they could summarize the need for the consult in 5 words or less. Why fever? Best therapy for Staph bacteremia. Although they often could not, which I took as a sign they didn’t really understand the patient need for a consult. I did this, as I learned long ago that I did not want the bias others accompanying me into the patient’s room. I wanted, no needed, to collect the information my way. Plus, over the years, the ability of residents to give a good presentation had faded. Yeah, I am one of those old geezers who talks about what it was like back in my day, but back in my day we had to be able to summarize the complete patient history is 6 minutes and were only allowed a 3×5 card for reference.

. . .

[snot]

1. YES.

About 20 years ago, I had a health problem. I was immediately referred to a surgeon who fixed it within a week, and I was back up to normal within another week.

This year I had the same type of problem. It took more than 4 months before I was allowed to have the needed surgery, during which time not only was I in terrific pain and partially disabled, but the certain aspects of the problem got much worse, so that the surgery was more extensive and the recovery more difficult.

One of the many tribulations along the way was that the only means of communicating with anyone other than a third-party answering service was the doctors' online portals. Here's what through trial-and-error I gradually figured out I had to do in order to log into one one of these portals once I'd created an account there:

When I first try to log in, the portal tells me my account has been locked because there've been too many log-in attempts, even if it’s my first attempt to log in (and even if a representative I called previously has supposedly "unlocked" the account); and it tells me to request a new password.  

When I enter my user name, d.o.b., & email address to request a new password, it tells me that the info does not match the system's records and that my email address must be the one I used to register on the portal.  I am copying and pasting the same email address, password, etc. each time I try to enter or "create a new account," so I don't know why they wouldn't match the system's records.

When I try entering the only other email address I could have used, it tells me the same things.  

When I look for help, the button labelled "Help" tells me I should contact "the appropriate office," but the spaces for which office that is or how to reach them are left blank.  There is, however, a sentence elsewhere on the page saying, "Need to contact the office?  Pls contact your physician's office directly.”  

To contact my physician's office, I need to call what seems to be a third party service at 214-821-5266, which I do.  I spend a minimum of 2 minutes going through the automated system to reach a human, who sends me a new PIN to be used to get into the portal.  

When I return to the portal with the new PIN, the only way offered for me to use it is to pretend I'm creating a new account (since I was afraid of just creating additional accounts, it took me some time to figure out that, nonsensical though it seemed, that was the only way in).  I go through the motions of creating a new account, entering the new PIN and otherwise entering all the same info I entered when I created the account, including the answer to a security question. 
 
The portal then blocks me again, telling me that my user name is already in use – which it is, since it's the user name for my existing account.  I try again, creating a new user name.  (Note, i.e., that although I must enter all the same info to "create a new account" as I used to actually create the existing account, I must at least pretend that I'm choosing a new password, although it will in fact let me keep choosing the same one, but I canNOT get in by choosing the same user name.)

Once I’ve made it back into my account, I go into the account settings and change the user name back to my original username, although I'm not sure it's worth the trouble, since I'm always required to create a new one in order to get into my account – i.e., the function of having a user name seems to be completely dysfunctional.  But I guess I feel unsure as to whether some kind of rationality to this thing might arise in the future, plus I continue to feel a bit worried about somehow ending up with more than one account.

On top of all that, the intermediate doctor actually gave me bad advice about treatment; at least every other doctor including the surgeon has advised me not to do what the intermediate doc told me to do (and doing it may have helped made the problem worse).

On top of all that, my personal data including my social security number has TWICE been dumped onto the dark web via data breaches at two different third-party health care service-related companies.

Getting prescriptions refilled has also become more difficult. Our health care system has gotten totally Kafka-esque.

[erronis]

2. That's a horrible experience - and apparently very common. Altho most won't have your perseverence.

The "Medical System" I use - this is a term for the conglomeration of multiple practices, small hospitals, etc. - uses the Cerner health records system. Like everything that Oracle/Ellison touch, it is horrible. My cardiologist (and the whole department) and my oncologist all refuse to use the portal. From what I understand the interface is even worse on the provider side.

I do like the EHR that Labcorp uses for my blood work. Results come back within 24 hours with lots of helpful information and graphs, etc.

I miss the old days when my hometown doctor would handle 80-90% of the problems and only refer to a specialist for 10-20%. Now, the PCP is just a clerk handling "prior approvals" or the annual Medicare check-up.