2-17-11 Thursday Day +113

Status:  Feeling fairly well.

Events: At Hopkins for lab checks.  All hematology values look good, but we’re still playing whack-a-mole.  Liver enzymes are still up despite discontinuing antifungal and reducing anti-viral meds.  It may be some GVH (certainly goes along with dry mouth, dry eyes, and dry skin).

  Had a lung CT scan as a follow up, which showed some inflammation in my right lung.  Best guess is a continuing fungal infection, although I’ve been on some pretty powerful anti-fungal drugs for a long time.  It may be that with the return of my neutrophils, we’re just now seeing inflammation in response.  Going back on Monday for another lab check, and have reinstituted my anti-fungals.

  I neglected to mention something that happened Monday that impressed me.  Just when I was about to hop on the table to have my catheter removed the nurse practitioner said to everyone in the room, “Time-out.”  I was then asked my name, birthdate, had my patient ID checked, and asked what procedure I was having.  Several years ago, this “timeout” procedure was started in surgery to prevent medical errors (wrong patient, wrong limb, etc.).  I was pleasantly surprised that Hopkins uses it for minor procedures as well.

Comments:  And on the subject of improving medical care, I was happy to see IBM’s computer program Watson wallop the two most famous winners on Jeopardy.   This prospect augers in an era of using computers to a much greater degree assisting doctors in diagnosing and treating patients.

 Back on in the 70s, Dr. Larry Weed made some radical recommendations of how doctors should engage with the medical system.  One was what he called the problem-oriented medical record, in which you’d list the patient’s problems in the notes on the chart and clearly show your thinking.  He gave it an acronym, SOAP, standing for Subjective, Objective, Analysis, and Plan.  So you might write down S – feverish, sweating, O – temp 101, white count 12,000, boil on right buttocks, A – bacterial abscess, P= culture abscess and blood, start on anti-staphylococcal antibiotics.  Every problem the patient had would be written down the same way, and often you’d find the problems interconnected.

  He also realized that the medical education system was based on stuffing more and more data into doctors’ brains, both a futile and flawed methodology.  He noted that computers could hold much more information, freeing up doctors to use their logical and methodological skills to make sense of an overwhelming amount of information.

  Imagine a Watson packed with every textbook, medical journal, medical image, clinical trial, guideline, and clinical anecdote.  And the ability, as Watson showed on Jeopardy, to correlate them and communicate their value to humans.  Imagine being able to hook up with Watson via your smartphone or iPad.  Instead of having to memorize the differential diagnosis of recurrent paroxysmal atrial tachycardia (as at one time I did) you could use your brain to do more important things, including building a bond with your patient.  I believe the future is bright, and as Ken Jennings wrote underneath his Final Jeopardy answer, “I, for one, acknowledge our computer overlords.” Or as Buzz Lightyear would say, “To infinity and beyond!”

Love,

-Bruce