Monday, February 23, 2009

1961 electronic medical records

nearly 50 years later, and where are we?!

Feeling a little old

This past weekend, I started working as a hospitalist, with the goal of working about one weekend per month. I chose to do this to maintain this unique set of skills which I worked very hard in residency to obtain, to see different problems from the ones I see in my outpatient clinic, and to spend some time with other pediatricians. As I was hoping, it was a lot of fun, and it was interesting to see the variety of patients on the pediatric floor. Of course the majority of patients had respiratory problems, it being winter, but even among them, there was some variety. I found my sea legs fairly quickly, to my great relief.

I did feel a bit out of touch, however, like I had been passed by father time. When I did my residency, which was not very long ago, we had some parts of the medical record computerized; we were able to look up lab and radiology results online. Every morning, all of us had to walk around the wards, finding nursing notes with vitals, finding charts to write in, and signing verbal orders. This was a great time to check in with patients, parents, and most importantly, nursing, but it was certainly tedious and inefficient! At the hospital where I worked this weekend, most of the medical record has been computerized, and they are in the process of making the ordering process electronic. Needless to say, I was very excited and intrigued to try this new system! It was wonderful to have access to labs, radiology, dictations, and nursing notes on the computer, and actually, on any computer with internet access! What a change! I was pretty slow at using the system since it was brand new to me, but I'm sure that I'll get used to it. But, what was shocking to me was that I missed walking around looking at paper vital signs flow sheets... I was able to talk to the nurses and patients, but it was just different, a little less social. Some aspects were much better, like the graphs with the fever curve and computer-calculated ins/outs which eliminate relying on my math skills (a positive), and the previously hand-written narratives which were now legible! Yet, it made me feel a little old that I missed the old paper system. I can't imagine what it would be like for someone to learn this system without any experience with electronic records! Obviously, electronic health records are the future (in some places, the present!), and this change will likely change the medical culture, just as mp3s have changed the music culture. And, I suspect, just like LPs have a strong following even now in 2009, I suspect paper charts will have a strong following in 2020, but I, for one, will be relieved when I get EMRs in my office and the hospital EMR continues to progress.

I found an amazing video on YouTube from 1966 that I posted on my next blog. Please check it out!

Wednesday, February 4, 2009

You want passion? Let's talk food!!!

I can't stand it anymore. I read my own blog, and I fall asleep... Health care, costs, access, blah blah blah. I like to write about things I'm passionate about. And I generally am passionate about my job, except for this time of year, when I feel like I'm drowning in boogers. Although some of my patients happily eat their little green boogers, I'd rather dine on other snacks!

I was raised in a family where we ate dinner together every night, we had a salad every night, and we had dessert usually when we had company. Dinner was a fun, chatty event, and we kids helped cook and clean up afterward. Our father cut the bread, and, I believe, that was it for him! But my mother was an excellent cook. I learned to taste unusual foods that my parents enjoyed, including pig brains, mountain oysters, and tripe. I didn't necessarily like them all, but I did acquire a taste for at least trying anything once. Some things, like avocados, I hated as a kid and learned to love as an adult; others, like tripe, I still don't like. Yet, my parents' love of food and dining with family and friends was definitely passed on to all of us kids.

These days, I travel to eat. I exercise to eat. I dream of food. When I go somewhere, I try to research where I can eat interesting food. Sometimes, the best restaurants are ones we find by accident. Ethnic food is my preference, although this past Sunday, I had one of the best hamburgers I've ever eaten in my life in Coronado, just across the water from San Diego, at The Burger Lounge, I didn't think I was hungry when I entered the restaurant, but I didn't have any difficulty eating my burger and some outstanding fries. When it comes to eating ethnic food, Ethiopian is probably my favorite. I still remember the first time I ate at an Ethiopian restaurant - it was called The Blue Nile, as many are, and it was in Durham, NC. We ate at a traditional table with the woven basket, drank some delicious tej, and ate a wonderful variety of vegetarian dishes on the traditional bread, injera. From then on, I started to seek out such restaurants on my travels. One of my all time favorites is in Berkeley, called FinFine, The kitfo, an Ethiopian-style steak tartare, is outstanding, if you enjoy raw meat.

However, if we're talking passion, I need to talk about barbecue in North Carolina. Now, when my family moved there from New Jersey, I thought that the word barbecue was a verb or an adjective, but definitely not a noun. So, needless to say, when I was offered barbecue at our school cafeteria, I asked, in all innocence, "barbecued what?" The lunch lady looked at me strangely and answered, "barbecue." I politely repeated my question, and she politely repeated her answer. Just as an aside, there weren't many northerners in Winston-Salem at that time, and I think she thought I was as strange as I thought she was. Eventually, when I asked what kind of meat it was (remember, it was a school cafeteria, so color is meaningless, it's all the same shade of brown, even the chicken), she said pork, so I happily ate it. Not long after, our next door neighbor invited me to go with her to Lexington, NC, home of "western" barbecue and the famous Lexington Barbecue festival, This type of barbecue uses a ketchup-based sauce and only the pork shoulder; eastern barbecue uses the whole hog and a vinegar-based sauce. Both kinds are cooked over an open pit, traditionally with wood fires. Anyway, we ate at one of the famous old restaurants, and I liked the hush puppies, but I wasn't crazy about the barbecue. So, at this point in my young, naive life, I simply thought I didn't like barbecue much because I didn't like the tomatoey, sweetish sauce. Then, about four long years later, I saw the light, and it was in Goldsboro, North Carolina, home of Wilber's, The pulled pork was out of this world juicy, tasty, smokey, and had a wonderful zing from the vinegar-based sauce. That was it! I done been converted that very day, as some people around there might say. The restaurants along US 70, starting with Ken's in La Grange, going all the way to the coast, are all pretty safe bets, with some, like Ken's, being better than others. If you get a chance to go, remember to ask for "outside brown," which means the pieces of meat that are closest to the fire and have a crispy side. Better yet, try to get in on a real pig pickin' at someone's house. And ask if you can get there at 4am when they start the hog cooking. It is a slow, careful process, with lots of basting and stoking of the fire, and, as often happens when men stand around a fire for many hours, a fair bit of beer gets consumed! If I've managed to pique your interest in this delicacy and in the debate between the east and the west, check out this website: And please, as bumper stickers in eastern NC say, keep your maters off my pig!! I now have to wipe the drool off my keyboard and go and plan my next culinary adventure. Bon appetit!!!