Today in Horrifying Systems

Recently I listened to Econtalk’s episode on the doctor-patient relationship, which was primarily about a study showing that hospitalized patients did better when their care was supervised by their primary care physician. The study shows what it shows (although pilot studies are prone to not replicating), but implicit in the discussion was the idea that continuity of care was important because doctors remembering things is better than writing them down. This may be true, and the podcast in fact cover some of the problems with medical records*, but if so that is a profound failure of medical record keeping. Human memory is the last thing you want to trust your life to. I pay extra for the kind of doctors that spend actual time talking to me, and I still have to remind the one that that drug she loves has unacceptable side effects for me, every time I see her. I in no way trust her to remember something as dense and detailed as test results.¬†That’s why she writes them down.

My understanding is that many people do understand this, but fixing medical record keeping involves a huge government entanglement that stifles all progress. So we’re stuck with¬†human memory as the thing keeping us alive.

Note that there are good reasons to have your PCP supervising your hospital stay even if everything is properly written down, which is hospitals are full of specialists who aren’t even trying to coordinate care. You benefit immensely from someone thinking “how are these things going to interact?” In theory this should be done by a hospitalist, but they only have so much time and not doing it is much faster. But let’s not pretend we’ve proved human memory is in any way a good solution to any problem ever.

*EHRs simultaneously have too much information, taking a long time to complete and read, and don’t have space for information off the beaten path.