Doctor Loses License Because She Doesn’t Know How to Use a Computer

[mope54]

I'm a medical student. Medical knowledge on common diseases changes every couple of months. That knowledge is most readily available on the internet.

I asked for an example. Please provide a specific example of a common disease that a family doctor would need to diagnose that has been updated within the past two months.

Also, what do you mean the most common place to get updated information is "the internet?"

If you are referring to online resources for your research, they come from peer reviewed journals. I hope you know that while *some* are available online, the journals are still sent out in paper format. You don't need a computer to access the most up to date information.

I sincerely hope your professors have not told you that "common" medical knowledge is so volatile that it's changing every few months! The corollary of that would be that your formal education is outdated.

 

[Liquid_Static]

I asked for an example. Please provide a specific example of a common disease that a family doctor would need to diagnose that has been updated within the past two months.

Also, what do you mean the most common place to get updated information is "the internet?"

If you are referring to online resources for your research, they come from peer reviewed journals. I hope you know that while *some* are available online, the journals are still sent out in paper format. You don't need a computer to access the most up to date information.

I sincerely hope your professors have not told you that "common" medical knowledge is so volatile that it's changing every few months! The corollary of that would be that your formal education is outdated.

Wow you're really reaching here. I said that "medical knowledge on common diseases changes every couple of months." I did NOT say "common medical knowledge changes every few months". That being said your following statement is true, formal medical education is outdated at a much faster rate than many other fields. It's why in many states of the good ol' USA continuing education hours are required to continue practicing medicine. While much of what we learn doesn't change (gross anatomy, histology, pathology, immunology etc.) how we APPLY that knowledge changes all the time and scientific/clinical understanding of these topics constantly deepens. In addition we don't spend all of our hours in medical school simply learning (for lack of a better word) stuff. We spend a lot of time learning how to think; critical analysis skills, clinical decision making, information gathering etc. We also spend a ton of time learning all the other competencies expected of physicians (ethics, law, interpersonal skills, interprofessional skills etc.)

And yes I am completely aware that peer-reviewed journals are the primary distribution mechanism of primary and clinical research findings. I'm also aware that those very journals are still published in a paper format that can be delivered to your door. The problem is the volume of studies being published as the result of increased medical research. If you legitimately think you can flip through issues of the NEJM, BMJ, JAMA, Lancet etc. and retain EVERYTHING you can apply to clinical practice you are absolutely delusional. We live in an age where that isn't just inefficient, it is irresponsible! A physician must remember as much as they can with regard to the standards of care but they must also be able to find information they don't have on hand in a timely manner in the interest of their patients.

As for your other question "Please provide a specific example of a common disease that a family doctor would need to diagnose that has been updated within the past two months." it doesn't really make sense but I think I know what you're getting at. Unfortunately it isn't as simple as you would like it to be. Standards of care are dependent on many more things than the disease itself including the patient, environmental factors, drug availability, costs etc. The physician works with the patient to analyze all of these things and work towards a solution best for them. How much weight to apply to each variable is a dynamic and constantly shifting question that is updated all the time by new medical knowledge. Regardless here is a nice summary of all the changes in the standard of care of diabetes for 2017. http://care.diabetesjournals.org/content/40/Supplement_1/S4 Here is another on the efficacy of a combined pharmacological approach for the treatment of gout http://onlinelibrary.wiley.com/doi/10.1002/art.39840/full If you're a stickler for the two month requirement here is another on the treatment of a sore throat http://www.bmj.com/content/358/bmj.j3887

 

[jedijeb13]

If she can’t use the internet there is no way in hell she is keeping up with current standards of care. In the interest of her patients she needs to retire.

As mentioned above, all of the pertinent journals are available in hard copy, and most doctors subscribe to and read the ones with the most important information as a common practice. Younger people seem to think that all information has always been available online. I know some journals that are just now being published online. Some of the ones I need for chemistry just went online in the past 5 years or less. I have also found less misinformation in hard copy than what I have found online. I have to remind people all the time, just because something is online, doesn't make it true.

 

[slats]

I asked for an example. Please provide a specific example of a common disease that a family doctor would need to diagnose that has been updated within the past two months.

Also, what do you mean the most common place to get updated information is "the internet?"

If you are referring to online resources for your research, they come from peer reviewed journals. I hope you know that while *some* are available online, the journals are still sent out in paper format. You don't need a computer to access the most up to date information.

I sincerely hope your professors have not told you that "common" medical knowledge is so volatile that it's changing every few months! The corollary of that would be that your formal education is outdated.

As long as she doesn't make me wait for two hours I'll take her over any of the general practitioners of today. So the state, a group that is absolutely the least technologically adaptive entity on the planet says this. This is asinine, but I wouldn't expect any less from a federal, state or local government. I bet this doctor spends greater than 80% of her day specifically on patient care which is what she should be doing. There was a time when a family doctor was a viable resource for the American family, their opinion was valued because it was based on years of medical experience. Today GP Doctors are expect to be licensed prescription writers, nothing more. It doesn't bother me to see any elderly person practice their profession as long as they are viable. Good for her!

 

[wolfofone]

An elderly doctor is fighting to regain her license after losing it due to a lack of computing skills. Dr. Anna Konopka insists that her paper system for keeping track of patients’ medical conditions and various prescriptions works fine, but the New Hampshire Board of Medicine disagrees. It is challenging the 84-year-old New London physician’s record keeping, prescribing practices, and medical decision making.

Part of their concern is her remedial computer skills, which prevent her from accessing and using the state’s mandatory electronic drug monitoring program. The program, which the state signed onto in 2014, requires prescribers of opioids to register in an effort reduce overdoses. Konopka doesn’t have a computer in her office and doesn’t know how to use one. Two file cabinets in a tiny waiting room inside a 160-year-old clapboard house hold most of her patient records. The only sign of technology in the waiting room is a landline telephone on her desk.

Why not just hire someone to help her with the record keeping and database entry? She can do the doctoring and her assistant can deal with the technology and electronic recordkeeping regulations.

 

[mope54]

Wow you're really reaching here.

Regardless here is a nice summary of all the changes in the standard of care of diabetes for 2017. http://care.diabetesjournals.org/content/40/Supplement_1/S4 Here is another on the efficacy of a combined pharmacological approach for the treatment of gout http://onlinelibrary.wiley.com/doi/10.1002/art.39840/full If you're a stickler for the two month requirement here is another on the treatment of a sore throat http://www.bmj.com/content/358/bmj.j3887

I'm curious if I'm reading this correctly, since you're accusing me of reaching...

the first study states: "Although levels of evidence for several recommendations have been updated, these changes are not addressed below as the clinical recommendations have remained the same."

the second study is an additional treatment if patients are non-responsive to traditional gout treatment.
a general practitioner would start with the traditional treatment and then either refer out to a specialist or perhaps look up if there was some additional methodology to try. this doesn't represent a "change" in treatment as you implied in your earlier responses so much as an additional option that might help.

lastly, steroid treatment for sore throats is not currently recommended (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701759/). Numerous doctors have raised concerns over the recommending the use of steroids to treat sore throats (http://www.bmj.com/content/358/bmj.j3887/rapid-responses, https://www.webmd.com/cold-and-flu/news/20170418/is-it-wise-to-take-a-steroid-for-a-sore-throat#1). This is clearly an example of what I warned about in an earlier response to this thread: practitioners pulling up the latest speculative research regarding common ailments and using that to treat their patients would be doing a disservice.

I'm surprised that you, as a medical student, would argue that someone coming into your office for a common sore throat should be treated with a methodology that only yielded moderate results for 1/3 of the study group. Weighing that against the risks of the use of steroids, it's difficult to understand why you think that represents a good example of your points.

I do think it's important to push medical knowledge forward, but it's not appropriate to pass cutting edge speculation to your clients for common issues. I would not appreciate being treated as a guinea pig and, if you have enough adverse reactions, neither would the medical board. As I wrote earlier, if I had a major issue or terminal condition, I'd want everything under the sun thrown at me...including untested or risky procedures. But I wouldn't go to a general practitioner under those conditions and I wouldn't expect my family doctor to have any more information other than thinking I needed to see a specialist. My family doctor checks me out every six months. For everything else, and I'm pushing 50 so things do come up with varying levels of frequency, I go to a specialist.

 

[Exavior]

Shame on this woman for trying to put her 60 years of medical experience up against the opiate reporting system of the state of New Hampshire.

Fuck them and all their computers.

What about the people she didn't treat correctly that have reported her to medical board for improper care? fuck them also?

 

[mope54]

What about the people she didn't treat correctly that have reported her to medical board for improper care? fuck them also?

The patients, according to the article, are petitioning and testifying on her behalf.

The only case mentioned in the article was the 7 year old son and his parents weren't the ones who filed the complaint. Searching the internet yielded other complaints, but they also were filed by a doctor.

 

[Deleted member 93354]

What about the people she didn't treat correctly that have reported her to medical board for improper care? fuck them also?

Doctors get a lot more complaints than you realize. Why do you think malpractice insurance is so freaking high?

 

[Exavior]

Doctors get a lot more complaints than you realize. Why do you think malpractice insurance is so freaking high?

yes, and when a medical board finds their actions bad enough that they don't think that they should be treating people anymore i would expect them to have their license revoked also.

 

[Liquid_Static]

I'm curious if I'm reading this correctly, since you're accusing me of reaching...

the first study states: "Although levels of evidence for several recommendations have been updated, these changes are not addressed below as the clinical recommendations have remained the same."

the second study is an additional treatment if patients are non-responsive to traditional gout treatment.
a general practitioner would start with the traditional treatment and then either refer out to a specialist or perhaps look up if there was some additional methodology to try. this doesn't represent a "change" in treatment as you implied in your earlier responses so much as an additional option that might help.

lastly, steroid treatment for sore throats is not currently recommended (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701759/). Numerous doctors have raised concerns over the recommending the use of steroids to treat sore throats (http://www.bmj.com/content/358/bmj.j3887/rapid-responses, https://www.webmd.com/cold-and-flu/news/20170418/is-it-wise-to-take-a-steroid-for-a-sore-throat#1). This is clearly an example of what I warned about in an earlier response to this thread: practitioners pulling up the latest speculative research regarding common ailments and using that to treat their patients would be doing a disservice.

I'm surprised that you, as a medical student, would argue that someone coming into your office for a common sore throat should be treated with a methodology that only yielded moderate results for 1/3 of the study group. Weighing that against the risks of the use of steroids, it's difficult to understand why you think that represents a good example of your points.

I do think it's important to push medical knowledge forward, but it's not appropriate to pass cutting edge speculation to your clients for common issues. I would not appreciate being treated as a guinea pig and, if you have enough adverse reactions, neither would the medical board. As I wrote earlier, if I had a major issue or terminal condition, I'd want everything under the sun thrown at me...including untested or risky procedures. But I wouldn't go to a general practitioner under those conditions and I wouldn't expect my family doctor to have any more information other than thinking I needed to see a specialist. My family doctor checks me out every six months. For everything else, and I'm pushing 50 so things do come up with varying levels of frequency, I go to a specialist.

Dude you keep taking what I say and move it one step forward and frankly it’s annoying. I never said you should treat a sore throat with steroids based on that paper. You asked for a recent paper that added to medical knowledge on a common ailment a family med doc would see. That’s exactly what I did, I never said you should use solely that information to treat a patient. As a physician it is your JOB to stay as up to date on medical knowledge as possible and to use that information to aid your patient. Today the internet is the best way to do that. Yes you can read paper journals but the information is simply not as accessible (especially later down the line when you’re trying to remember what issue you read something in and what exactly it said).

The amount of evidence is what determines how relevant a clinical recommendation is. This is incredibly important and I don’t understand how you can dismiss it.

Ok, no one is reffering you to a specialist for gout (unless it’s horrible, then you might get referred to a rheumatologist). Regardless trying an additional medication is totally in the realm of a family med doc. AN ADDITIONAL OPTION IS A CHANGE IN TREATMENT YOU NEED TO KNOW ABOUT.


“I'm surprised that you, as a medical student, would argue that someone coming into your office for a common sore throat should be treated with a methodology that only yielded moderate results for 1/3 of the study group.”

I literally never said that. You’re adding to what what I’m saying, it’s a common rhetoric strategy and incredibly annoying - stop.
Steroids are an area of active research, this paper adds knowledge to the pool of information regarding them and sore throats. That is how science works.

I agree with you in that no one should just use recent research to treat patients. Doing so is unethical and unprofessional. It is however a physicians responsibility to stay as up to date on this research as possible. Again, there is no better way to do his than the internet.

 

[mope54]

Again, there is no better way to do his than the internet.

The claim you made was not in regards to efficiency but in efficacy.

An additional option to treat gout is a change in treatment, but there is no justification to claim that someone who learns about it via a publicized journal instead of the internet is doing their patients a disservice, which was the original claim made that I was disputing.

The accessibility of a paper journal vs an electronic one is subjective. You have an opinion that the internet is the best method for you to obtain your information, but it's not a fact true for everyone as you claim in your posts. Many people, this doctor we're discussing in particular, do not agree electronic information is more accessible. That opinion does not make someone a bad practitioner, which is the claim you were trying to argue.

 

[Deleted member 93354]

The claim you made was not in regards to efficiency but in efficacy.

An additional option to treat gout is a change in treatment, but there is no justification to claim that someone who learns about it via a publicized journal instead of the internet is doing their patients a disservice, which was the original claim made that I was disputing.

The accessibility of a paper journal vs an electronic one is subjective. You have an opinion that the internet is the best method for you to obtain your information, but it's not a fact true for everyone as you claim in your posts. Many people, this doctor we're discussing in particular, do not agree electronic information is more accessible. That opinion does not make someone a bad practitioner, which is the claim you were trying to argue.

It's been proven in a number of studies now that people retain more if they read from paper media than electronic.

 

[Liquid_Static]

The claim you made was not in regards to efficiency but in efficacy.

An additional option to treat gout is a change in treatment, but there is no justification to claim that someone who learns about it via a publicized journal instead of the internet is doing their patients a disservice, which was the original claim made that I was disputing.

The accessibility of a paper journal vs an electronic one is subjective. You have an opinion that the internet is the best method for you to obtain your information, but it's not a fact true for everyone as you claim in your posts. Many people, this doctor we're discussing in particular, do not agree electronic information is more accessible. That opinion does not make someone a bad practitioner, which is the claim you were trying to argue.

Efficiency and efficacy are not separate concepts like you’d like them to be. Imagine if your EM doc flipped through a giant encyclopedia as you’re choking in the waiting room.

This is assuming you can remember the proposed change. It’s a lot easier to double check using the internet when the patient is in the room than flipping g through a stack of dust journals in the next room,

Electronic information is more accessible more quickly than printed information because of ctrl-f. Refusing to learn how to access electronic information is irresponsible.

 

[Liquid_Static]

It's been proven in a number of studies now that people retain more if they read from paper media than electronic.

The problem is that you can’t possibly retain everything you need to know, at some point you’ll have to look something up.

 

[mope54]

Efficiency and efficacy are not separate concepts like you’d like them to be. Imagine if your EM doc flipped through a giant encyclopedia as you’re choking in the waiting room.

This is assuming you can remember the proposed change. It’s a lot easier to double check using the internet when the patient is in the room than flipping g through a stack of dust journals in the next room,

Electronic information is more accessible more quickly than printed information because of ctrl-f. Refusing to learn how to access electronic information is irresponsible.

Efficiency and effectiveness are distinct concepts and that fact is not subject to my likes or dislikes regarding that reality.

Regardless, let's try and keep this conversation in context. I did not make a blanket statement about all medical information. I am discussing whether this specific family doctor can effectively serve her patients without the internet. She is not working in an emergency environment. That said, no emergency doctor is going to flip through an encyclopedia *or* do a quick internet browse while a patient in choking in the waiting room. This conversation is going off the rails.

 

[Deleted member 126051]

Not to the New Hampshire Board of Medicine. It's obvious that they disagree with your assessment.

That's fine. Remember that the IQ of a group is essentially that of the member with the lowest IQ, divided by the number of people in the group.

And simply because they agree with something doesn't mean they're correct.

 

[Deleted member 126051]

Efficiency and efficacy

Okay. Go back and read yourself a dictionary then.

Efficiency is about successfully accomplishing something with minimal waste.

Efficacy is about successfully accomplishing something with best results.

 

[Deleted member 126051]

The problem is that you can’t possibly retain everything you need to know, at some point you’ll have to look something up.

And this doctor's preferred method of looking things up is dead trees.

So what are you on about?

 

[magoo]

The entire original article here was about the doctor not having a computer to log into the state's narcotic data base.
Almost every state has one of these now and does require one looking up a patient before prescribing narcotics, to look for signs of abusive behaviour.

That being said, there are plenty of deferrals flying around. My hospital has a prescribing deferral now going on 4 years because the system we use can't or doesn't interact with the national prescribing data base.
The rest of the state is mandated to Rx online.

This doctor is not incompetent. She is practicing standard of care medicine which does not require a computer, last time I looked.
Medicine in it's basic forms does not evolve as rapidly as people here are led to believe.
Yes, there are amazing technological advances in surgery and advanced cancer treatment, but that is not what this lady practices.
Basic general practice hasn't changed much since the 1960's honestly. Yes there are newer drugs and more vaccines, but the fundamentals are still the same.

There are dozens of ways to stay current in medicine that do not require a computer as well. No one pulls out the latest medical journal and reads some obscure article about a novel approach to treating patients and starts doing it.
Care evolves through tried and true practice and adjustments based on new drugs and huge controlled trials.

The medical students here are pounding their chests but will find that once they are in practice, they too will find medicine to humble them daily, and no computer will be able to replace what they were taught, be it 1 years ago or 50.

 

[lcpiper]

That's fine. Remember that the IQ of a group is essentially that of the member with the lowest IQ, divided by the number of people in the group.

And simply because they agree with something doesn't mean they're correct.

Well I'll just forward that on to the Doctor so she can draw comfort from it.

 

[lcpiper]

And this doctor's preferred method of looking things up is dead trees.

So what are you on about?

This matters not at all. The only thing that matters is why the board made the decision to take her license and it didn't have to do with staying current with anything other than her legal responsibility to create and access entries in an online resource. That she still prefers medical journals to blogs or whatever else isn't going to have any effect on the outcome here.

 

[Deleted member 126051]

This matters not at all. The only thing that matters is why the board made the decision to take her license and it didn't have to do with staying current with anything other than her legal responsibility to create and access entries in an online resource. That she still prefers medical journals to blogs or whatever else isn't going to have any effect on the outcome here.

Oh ho ho. You're SO funny and witty! I've been presented with a fait accompli so that's me told!

Ow. Sorry, my eyes automatically rolled so hard I need to see an optometrist now.

 

[lcpiper]

Oh ho ho. You're SO funny and witty! I've been presented with a fait accompli so that's me told!

Ow. Sorry, my eyes automatically rolled so hard I need to see an optometrist now.

Oh ... wait ..... give me a few minutes to google that....................total lack of argument.

If this is recognition and acceptance, I'll allow it.

 

[Deleted member 126051]

Sorry, your "argument" (and the board's) is an appeal to authority. In short "Because we said so."

No actual data behind it. Just excuses to prop up a blind preference.

But please, feel free to make up some more bullshit "arguments".

 

[cyberguyz]

I'm saying a doctor that doesn't use every possible resource available to them can still be a good doctor. Are you claiming that any doctor that doesn't is a bad doctor?

I see people have posted claims against this doctor. I'm curious how many claims does the average doctor have against them?

I have seen many, many doctors depend on strictly manual and paper misdiagnose, or fail to diagnose at all, serious conditions often leading to the death of their patients because the patient depended on his doctor to be competent and use every tool in available to them in their profession. I have seen my own GP move from a completely paper & manual system to using technology in his work. His diagnosis 'hits' are markedly improved as well as his knowledge of newer techniques and treatments. I have seen this improvement 1st hand and at my age I depend heavily on his ability to keep himself up to date and relevant in the medical profession.

Doctors today have a larger and larger patient load than they did even 20 years ago. They don't have the time anymore to depend on obsolete knowledge, patient management and tracking techniques.

 

[serpretetsky]

I have seen many, many doctors depend on strictly manual and paper misdiagnose, or fail to diagnose at all, serious conditions often leading to the death of their patients because the patient depended on his doctor to be competent and use every tool in available to them in their profession. I have seen my own GP move from a completely paper & manual system to using technology in his work. His diagnosis 'hits' are markedly improved as well as his knowledge of newer techniques and treatments. I have seen this improvement 1st hand and at my age I depend heavily on his ability to keep himself up to date and relevant in the medical profession.

Doctors today have a larger and larger patient load than they did even 20 years ago. They don't have the time anymore to depend on obsolete knowledge, patient management and tracking techniques.

Good to know. May I ask what your background is that you have access to see many doctors misdiagnose and see improvements when they move to a more technological solution?