Health care insurance entities and plans proliferated. (=More clerical burden for docs.) They were forced to cope, and had to hire clerical workers not just to bill, but to ‘code’ for billing. Have a look: could you keep up? It’s ICD-10/9 as of 2021…cms.gov/Medicare/Coding/ICD1…

Meanwhile, research had advanced and NIH tried to put it online, but it was hard to use. When I went back for my dad’s funeral in 1989, a UPenn-educated obstetrician asked if I had any influence in the interface that would make it usable…

Now we have the Web, and Google Scholar, and NCBI and others for doctors, some info behind pay walls after med school. A few big hospitals have put up medical information aimed at helping consumers, but at the bottom somewhere is the business pitch: “ To make an appointment…”

With the proliferation of information, *IF* a pt has access to online information, Topol notes a new challenge for doctors: the info available may mislead non-doctors. That can confuse taking a history and making a diagnosis.

Meanwhile medical specialties proliferated. In the 60s & 70s, specialists came to our little semi-rural area. There was a tradition of good schools, and a highly selected private liberal arts college there. Good place to live and raise kids. General practitioners had to cope.

By shortly before dad’s death in 1989, specialization morphed into clinics. Dad described a young doctor in his medical society meeting reacting to a specialty sleep clinic in an adjacent county that was bussing patients to it from other counties as “Pure greed.”

So: massive clerical, administration, regulation, research info, practical info, drug info, specialist correspondence, federal/state/local wrinkles, types of facilities. Also types of nurses, assistants, receptionists, office managers, technicians, labs, sources of PPE…

…there’s all that in the background sucking up 15 of your 20 minute appointment 🙃…

Oh, and husband, father to four girls, brother to three female siblings, free family medical information resource. Ice skater, fisherman (in lakes and streams overblown by the recent train wreck a few counties away over the state line.

I think Topol’s targets are a start. More power to him and Hopkins. There are efforts underway to extend online accessibility, so telemedicine can help for some parts of ‘care.’ I agree with Topol that there is a lot of human touch that has to be dug out of the clerical overload