tag:blogger.com,1999:blog-7772182113499451603.post658986458211778275..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: "Good News - Your Care Today Was Free"George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-7772182113499451603.post-65179594780404387762014-07-14T12:13:47.666-05:002014-07-14T12:13:47.666-05:00Someone sent me this link I had to share given the...Someone sent me this link I had to share given the topic:<br /><br />http://www.gomerblog.com/2014/07/electronic-health-record/James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-12460722142259595442014-07-13T09:56:09.247-05:002014-07-13T09:56:09.247-05:00From the ur-time of Max Hamilton who developed psy...From the ur-time of Max Hamilton who developed psychiatric rating scales for anxiety and depression back in the late 1950s it has been understood that they are for tracking severity of symptoms, not for making diagnoses. Why? Because most symptoms are nonspecific. First you make the diagnosis, then you use the rating scale to obtain a baseline from which you can follow progress. In recent years various entrepreneurs have pushed to skip the first step and to reify the number from a scale.<br />Bernard Carrollhttps://www.blogger.com/profile/16203083806436919715noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-64586554370589655602014-07-12T14:51:42.964-05:002014-07-12T14:51:42.964-05:00Or even old school crime. The VA hunted me by down...Or even old school crime. The VA hunted me by down via tax records to let me know my medical records may have been compromised when one of their workers took home a laptop full of medical records that was later stolen. <br /><br />Meanwhile at this time, managers where I worked were hounding me about how I needed to maintain data privacy because of government regulations (also while ignoring that the only content I currently worked with was being displayed on the firm's website). The irony wasn't lost on me.<br /><br /><br />RBnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-13058517602278409262014-07-12T11:45:58.836-05:002014-07-12T11:45:58.836-05:00More reason that psychiatric records should be old...More reason that psychiatric records should be old school SOAP and process notes on paper in a locked file cabinet.<br /><br />http://www.fastcompany.com/3000470/medical-cybercrime-next-frontier<br /><br />Using an numerical code instead of names would even stop a breach if there were an Ellsberg type break in. <br /><br />Sometimes low tech is superior.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-79535919281648560892014-07-12T10:27:37.688-05:002014-07-12T10:27:37.688-05:00I would guessed it was a bite from a sac spider. B...I would guessed it was a bite from a sac spider. Brown recluse spiders do not live in Minnesota. I usually won't fill out that questionnaire you refer to. It doesn't ask how intense the symptoms are, only how often. What a stupid form it is!Occasional commenternoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-44288042015769572422014-07-12T00:10:20.852-05:002014-07-12T00:10:20.852-05:00Most of the numbers used to measure "health&q...Most of the numbers used to measure "health" are as irrelevant to the health of the patient as the body counts used to measure the "success" of whatever the latest war is.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-36606008264774739942014-07-11T22:28:25.476-05:002014-07-11T22:28:25.476-05:00I think it is just a matter of time.
In fact, I ...I think it is just a matter of time. <br /><br />In fact, I think it has already happened, but the company who did it changed their mind. I will know enough to take a screen shot of the first company I see with that service and post it here. There is a measurement based care initiative within psychiatry that is a proponent not just of these measures but many more. I see it as a reaction to the business community: "They criticize us because we claim that we cannot be measures like everyone else." <br /><br />If there was enough honesty around, there would be an admission that many specialists doubt the importance of measurement or dispute the measures. An internist told me that his group was being "paid for performance" on a BMI in the 26-27 range. When he produced current research saying that a BMI of 28-30 did not result in any increased mortality it was dismissed out of hand. <br /><br />I think that people may come to see performance for what it really is - political leverage.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-80805221952203103382014-07-11T22:18:16.221-05:002014-07-11T22:18:16.221-05:00Here's the big lie no one talks about...the go...Here's the big lie no one talks about...the government is good enough to keep your health information secure, but not good enough to keep the names of their double agents in Pakistan secure. <br /><br />I just assume everything that gets on EHR is eventually going to be for public consumption. Which is a good reason for psychotherapists and psychiatrists to go off the grid completely.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-28122624530841239812014-07-11T22:13:19.214-05:002014-07-11T22:13:19.214-05:00Agree completely - the cloud to me is a concept ou...Agree completely - the cloud to me is a concept out of a science fiction movie. There is the illusion you you have access, but of course health care companies never give you complete access to your records because it is their property. More importantly - they want the trend to be that your financial and health acre information at some point to be as accessible to corporations as your Facebook page and that movement has been building since the 1970s. Right now businesses have easier access to healthcare records than physicians do. The evidence is as obvious as the hundreds of thousands of records lost from the laptops of these businessmen. Congress is basically an organization for creating businesses out of thin air and there is no better example than the electronic health record sold on the lie that it was going to save us all billions.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-56685451757807744542014-07-11T19:58:28.916-05:002014-07-11T19:58:28.916-05:00To your knowledge, are there similar online consul...To your knowledge, are there similar online consultations via insurance coverage that use a PHQ-9? It's a scary thought. <br />It reminds me of a lecture I went to years ago, about Autism, where they showed this video of a little triangle moving around a large rectangular area, followed by a big triangle. Everyone in the audience went, Awww, what a cute little triangle, being chased by that big, mean triangle. And then we were told that all the autistic people who had been shown that video described a smaller triangle, a larger triangle, and a rectangular area.<br />I know MIT has some very sophisticated, and presumably expensive, AI that might be able to pick up on the discrepancy between a patient's answer on the PHQ-9, and how that patient appears. But given the cost limitations in psychiatry, I doubt that type of technology is available. <br />So it amazes me that the powers that be have been able to convince themselves that a PHQ-9 plus a case manager is "just as good" as an experienced psychiatrist interviewing the patient. Or maybe they haven't convinced themselves, and they just don't care.<br />Hope your ankle's better soon.PsychPracticehttps://www.blogger.com/profile/07071440888782115503noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-17137624719525119032014-07-11T19:11:20.730-05:002014-07-11T19:11:20.730-05:00Medical and psychiatric information should be on e...Medical and psychiatric information should be on encrypted thumb drives, not on the Internet. The whole concept of EHR as a cloud based or server based system is deeply flawed in the age of Wikileaks. But that doesn't matter, EHR vendor GE pays 100K day for lobbying, created MSNBC to be court flatterer of the administration and is raking in the bucks big time for something that doesn't work.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.com