Me(2010 ish): Hey can I get my x-ray pictures before I leave?
Doc: No, there's no way to get pictures off of this computer
I had the pictures saved on a flash drive about 30 seconds after he left the room. They were using some awkward browser-based system where everything was served as an html page. It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.Just a personal anecdote.
> It was still quite concerning that someone that spent 4-8 in med school lacked even basic computer skills.
That doesn't surprise me, for the same reason I can't tell you what a metatarsal is without googling.
What did surprise me, was that my dad had a home PC with internet for years before realising that Google search results had a scroll bar — it's not like he didn't know how computers worked, before retirement he'd been working as a software developer for one of the big UK defence contractors.
Can't comment on Google specifically but hidden scrollbars mean I often don't realize a dialog has scroll bars until I reach out into the dark edges to find what I hope is there. Microsoft will even harness this as a dark pattern to hide options they don't want you to choose.
Perhaps your dad simply expected to scrollbars to be visible like they initially were.
This was before scrollbars got routinely hidden like that, it was in the mid to late 2000s. He retired in the late 90s.
> years before realising that Google search results had a scroll bar
If that happened now he would have never seen anything except adverts.
Sometimes I see almost only ads not on the first screen but on the first _page_.
The longer I live, the more I see Physicians as people who are bad at math and/or who have parents who are physicians.
There are a few people that are nither, but I think its safe to say at least 50% of physicians qualify as this.
Metatarsals don't come up in your daily work. Using a computer is a constant daily task for a doctor. In this example he failed to use it properly and just said it didn't work instead. That's not really OK.
Almost certainly saving the image was a violation of hipaa policy— giving emr records without the proper logging/etc can get the doc fired. The patient had a right to their images, but it’s like anything enterprise, getting it has to go through the proper channels.
You can probably imagine the privacy problems if that image were saved out of the cache directory.
I don’t think criticizing doctors for not knowing you can right click save image as makes any sense because it’s not an important part of their work.
Imho, the first thing doctors need to learn (at least in my country) is to touch type. I've had it with 5 min exams followed by 15 minutes of pecking to type in the necessary forms. Multiply by number of patients in a day and it adds up, and it's prevalent, family doctors, dentists, specialists, nobody bothers to learn it. Gets tiresome when you know you're in the waiting room for a couple of hours because they are slow at typing.
I used to do support for a service that did transcription for doctors. The doctors would call in and tell the medical transcriptionist what to type and they would do the input.
It always seemed incredibly inefficient and expensive but hospital management told me this was the most dependable way to get accurate records and even a single lost lawsuit would cost more than the service.
It's stupid, but that's the world we live in.
No. Just no. Teaching doctors touch typing is tending to the secondary symptom of the fact doctors should not waste time inputting routine data.
What doctors need would be secretarial services trained in medical procedures.
And by the way, when I was a child, even before the computers came, here is how it worked in Russia.
The doctor was listening to my breathing, looking at the throat, asking me and my mother questions, and saying various medical phrases to her assistant, who was then writing them into my patient records (a thick paper notebook).
This is how all the dentists work that I've seen. Doctor plus nurse. Apparently dentists have more agency over their work environment than doctors do.
I think this is one of the use cases where speech-to-text and (AI) transcription tools would be useful. Of course ideally there'd be two people, one doing the medical stuff and the other then documentation, but health care is expensive enough as it is.
Medical scribes are a thing. Some provider organizations employee people who attend patient encounters and do all the EHR data entry in order to free up clinicians for higher value work. This generally works well, but it is expensive and payers don't directly reimburse for that service.
All the dentists I've ever visited have worked in doctor/nurse pairings. The nurse assists in operations AND is the data entry expert.
I think it's just about bureaucratic faux-economical thinking infringing to doctors workspace cutting overall effectiveness.
It turns out that peach to text is slower than dictating and having a typist type.
The speed at which reports are dictated is incredible and even when familiar with the field it’s hard to understand how the typists are getting it right.
> Of course ideally there'd be two people, one doing the medical stuff and the other then documentation, but health care is expensive enough as it is.
In the 1980s USSR, every doctor actually had a nurse who did the paperwork. And somehow, healthcare was still free.
What we need is a universal standard way to store all of our personal data on our phone and share whatever is relevant at whatever company/government at the touch of a button.
Nor a secretary nor a doctor nor anybody should have to hand-type data that already exists digitally.
I'm so mind-blown that this doesn't exist yet that I feel maybe I should try and build it. I have tried building the next-best thing: OCR based form filling, but hard to get far as a solo FOSS'er.
" this doesn't exist yet"
We have a national health database in Finland called "OmaKanta" (which translates to MyDatabase or something like that). It's not perfect but at least I can trust it with most of my health records, and it's accessible to all doctors working in both public and private sector.
Many healthcare provider organizations have standard HL7 FHIR APIs that patients can use to download their own chart records. There are a variety of apps that you can use to call those APIs.
Im talking about a standard GLOBAL way of sharing that exact same data AND all other personal data.
FHIR is a global standard.
I wonder if the Solid protocol might be helpful here? [0] I must confess I haven't toyed with it so far, but I am looking for an excuse to try it out.
[0]: https://solidproject.org/
Looks cool, but is more abstract/low-level than what I mean. Could maybe be used as a foundation for it though.
Problem: there are 19 competing standards
New problem: there are 20 competing standards
There are 0 standards for global sharing of all possible personal data. That I know of.
Touch typing for doctors seems a waste of time now that Dragon / Whisper / your phone can do Speech to text quickly and relatively reliably.
Sure, let’s send private medical data to a cloud server somewhere for processing, because a medical professional in 2025 can’t be expected to know how to use a keyboard. That’s absurd.
I can type quite well. I can also troubleshoot minor IT issues. Neither is a better use of my time than seeing patients.
I’m in an unusual situation as an anesthesiologist; I don’t have a clinic to worry about, so my rate-limiting factor isn’t me, it’s the surgeon. EMR is extremely helpful for me because 90% of my preop workup is based on documentation, and EMR not only makes that easy but lets me do it while I still have the previous patient under anesthesia. I actually need to talk to 95% of patients for about 30 seconds, no more.
But my wife is primarily a thinking rather than doing doctor, and while she can type well, why in the hell do we want doctors being typists for dictation of their exams? Yes, back in the old days, doctors did it by hand, but they also wrote things like “exam normal” for a well-baby visit. You can’t get paid for that today; you have to generate a couple of paragraphs that say “exam normal”.
Incidentally, as for cloud service, if your hospital uses Epic, your patients’ info is already shared, so security is already out of your hands.
This has been happening for years, long pre-dating LLMs or the current AI hype. There are a huge number of companies in the medical transcription space.
Some are software companies that ingest data to the cloud as you say. Some are remote/phone transcription services, which pass voice data to humans to transcribe it. Those humans then store it in the cloud when it is returned to a doctor's office. Some are EMR-integrated transcription services which are either cloud-based with the rest of the EMR or, for on-premise EMRs, ship data to/from the cloud for transcription.
Macs have pretty decent on-device transcription these days. That’s what I set up for my wife and her practice’s owner for dictation because a whole lot of privacy issues disappear with that setup.
The absurdity is that doctors have to enter a metric shit ton of information after every single visit even when there’s no clearly compelling need for it for simple office visits beyond “insurance and/or Medicare” requires it. If you’re being seen for the first time because of chest pain, sure. If you’re returning for a follow up for a laceration you had sewn closed, “patient is in similar condition as last time, but the wound has healed and left a small scar” would be medically sufficient. Alas, no, the doctor still has to dictate “Crime and Punishment” to get paid.
Most EHRs are sending that text input to the cloud for storage anyway. Voice transcription is already a feature of some EHRs.
Medical companies could self host their speech to text translation. At the end the medical data is also on some servers stored. So doing speech -> text translation seems just efficient and not too much worrying if done properly.
So you think the better solution to doctors not being able to try is for them to self-host a speech to text translation systems, rather than teaching doctors to type faster?
Their healthcare/IT provider like Epic would do it. And in fact some have already done it, from what I can see.
Furthermore, preparing/capturing docs is just one type of task specialization and isn’t that crazy: stenographers in courtrooms or historically secretaries taking dictation come to mind. Should we throw away an otherwise perfectly good doctor just for typing skills?
Who is responsible when the speech-to-text model (which often works well, but isn’t trained on the thousands of similar-sounding drug names) prescribes Klonopin instead of Clonidine and the patient ends up in a coma?
These models definitely aren’t foolproof, and in fact have been known to write down random stuff in the absence of recognisable speech: https://koenecke.infosci.cornell.edu/files/CarelessWhisper_E...
This isn't a speech recognition problem per se. The attending physician is legally accountable regardless of who does the transcription. Human transcriptionists also make mistakes. That's why physicians are required to sign the report before it becomes a final part of the patient chart.
In a lot of provider organizations, certain doctors are chronically late about reviewing and signing their reports. This slows down the revenue cycle because bills can't be sent out without final documentation so the administrative staff have to nag the doctors to clear their backlogs.
I imagine where the speech to text listens to the final diagnosis (or even the consultation) and summarizes everything in a PDF. Of course privacy aware (maybe some local hosted form).
And then the doctors double checks and signs everything. I feel like, often you go to the doctor an 80% of the time they stare at the screen and type something. If this could get automated and more time is spent on the patient, great!
None of those options are off-device.
> now that Dragon / Whisper / your phone can do Speech to text quickly and relatively reliably.
It’s less accurate and much slower than a human typist (or 3) typing dictated reports.
Tested over years in an MSK radiology clinic.
Wait - you accessed your doctor's computer after he left the room and downloaded data from it?
Sure did! I think you're vastly overestimating the security of... basically everything computer related in the 2010 and earlier era.
I did not poke around obviously, because I was only interested in my personal files and assumed I only had a few minutes. Could I have been 'evil' and accessed other stuff maliciously? Maybe idk.
Years before I also had root access to my entire school district's records and probably could have wiped them if I really wanted to. I'm not a hacker or programmer by any means, just a random idiot that figured out how to use ophcrack back when XP was the primary operating system. It was a different time.
I'm mostly just surprised that the doctor didn't lock the workstation when they left the room. Especially if it was a radiology workstation (rather than e.g. exam room EMR workstations); the sensitive data risk from leaving it unlocked is huge!
Like, I'm not saying that'd solve computer security or anything, someone could still break into a locked computer. But it would definitely raise the level of effort required to access medical data up from "has a flash drive and five minutes".
I'm sure doctors get the same lock-your-workstation trainings as the rest of us, and ignore them about as often. I wonder if smartcards would be appropriate here: since doctors are typically jumping between lots of "thin-client equivalent" computers around their practice all day, could we give them smartcards that need to be physically inserted in computers in order to log in? Pull the card, computer logs you out; don't forget your card in the exam room or you can't log into the next one.
Like, I'm sure they'd have tantrums (any kind of users would, at this transition), but putting that aside: this kind of system is technically cheap and has been well-supported for decades. Would the overhead of employing it at medical practices be preventative? Is it already employed at some practices? How does it work there?
> I think you're vastly overestimating the security of... basically everything computer related in the 2010 and earlier era.
My astonishment is unrelated to IT security. Your behavior is equivalent to just sneaking into the unlocked office of your doctor and taking photos of your file.
Well what's the alternative? Get in a week long battle with the hospital while they struggle to locate and send a 500kb jpg? I AM talking about the American healthcare system here.
Yeah, I'll just grab it myself. It was a standing workstation right in front of the exam table and he didn't even close the browser. Would have taken 3 seconds to lock and unlock if they cared about security.
Makes you wonder if they could have accessed and saved data from other patients as well.
"I topped up my bank account within 30 seconds after the bank clerk left the counter."
My experience as well, in a hospital a doc left me with sa fully logged in console, to feed my kid in his office (which is incredibly kind of course). I for one got that "walk afk = alt-f4" rammed into me at my work place at that time. Makes me think that there might be a face-id like unlock (and immediately lock) market out there for PCs...
I expanded on this in an adjacent comment: smartcards might be a cheap and easy solve here. Insert the card to log in, pull the card and you get logged out. Bonus points if the smartcard is also your access card for e.g. the break room.
Albeit whatever others said, I think it's PERFECTLY fine that you did that just for your own record. I'm not being cynical. Getting my own medical records is far from easy and I don't give a fuck anymore.
Will I do it? Probably not. But I salute all who does.
I wish people had basic computer skills too but I think it's a failure of software design if you expect a random working professional to know how to work around the lack of obvious functionality?
It’s even more concerning you obtained access to this system with ease. Sounds like a pretty serious security incident.
They probably just meant that protocol prevents them from giving you access to them.
My trick was to photograph the screens with my phone. A lot of the stuff wasn't html and genuinely quite time consuming to figure how to send.
Medicine is such an all-consuming pursuit that I'm entirely NOT surprised that a doctor might not have great computer skills.
Not knowing how to pull an image out of a web page is not something that will impact their ability to diagnose your malady.
Your flash drive must have been compromised. Every flash drive from med students are infected with viruses.
You'd think they know better and practice safe insertion.
This points to a wider misconception that the public has. Computer engineers learn how to build computer systems, they don't learn how to use computer systems. Automotive engineers are not necessarily good drivers either, and an architect can get lost in your building just as well as anyone.
Sure you get a lot of it through osmosis by spending a lot of time at the computer, but computer science professors struggle with projecting slides from the in-class computer just as much as high-school teachers.
My point is that, sure, it's reasonable to expect a doctor to know absolutely nothing about programming. But if using computers is such a central aspect to their job, it's not unreasonable to expect that they will be proficient in operating medical computer systems, probably better than computer engineers.
I'm not talking about programming. I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions, even those that are arguably more important.
Do you have basic knowledge of your own body? Anatomy, for instance? I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Or how many people who drive know what a catalytic converter is, or what symptoms are typical of it failing? Or even what to do when certain idiot lights light up on their dashboard? The check engine light comes on, do you stop on the side of the road or can you continue to your destination? Or can you continue, but just to a garage? Do you have to do so at reduced speed? How about if the oil light comes on? How about if the low tire pressure light comes on? How about if the airbag light comes on? How about if the battery light comes on? How about if the light with an exclamation mark inside a triangle comes on? How about the light that looks like a profile of the car with skid marks under it? How about the light with the cryptic three letters ABS?
> I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions
That was their point: keyboard, mouse, and basic computer interaction is general knowledge that anyone in modern life should have, like first aid or what traffic signals mean (for both vehicles and pedestrians).
Yes, and the doctor in question is skilled enough to use them. He uses them via hunt and peck, not touch typing, but that's good enough for his purpose.
> I'm talking about basic use of a keyboard and mouse. You just expected other people will know how, yet have no basic knowledge of other professions, even those that are arguably more important.
I'm a bit confused about what you are saying. Basic use of a keyboard and mouse is not exclusively part of the software engineering or IT profession. It is in fact part of every job where as part of your job you use a computer. Which is almost every job nowadays.
Same as writers are not the only people who are taught how to write, and accountants are not the only people who are taught arithmetics.
> I recently tore a rotator cuff, none of the four muscles mentioned I had ever heard of in my life. It would have helped me immensely had I not had to spend an evening googling what are actually basic medical facts.
Sorry to hear that, and I hope you are feeling better. Not really sure though what is your point. Are you saying doctors should not know about basic use of a keyboard and mouse because you haven't heard of the rotator cuff? Or are you saying that people should be also taught about the rotator cuff who are not doctors? I just don't really understand your point.
> Or how many people who drive know what a catalytic converter is, [...] How about the light with the cryptic three letters ABS?
I'm really not sure what your point is.
I'm saying that we should not expect people to use computers efficiently, rather we should expect people to use computers in a "good enough" fashion.
I think that more cross-discipline experience would benefit everybody.
Come now. You mean to tell me the same doctor doesn't use a computer at home, write emails, make an occasional document or spreadsheet for tax purposes, doesn't carry a smartphone in his pocket, text other people?
A doctor is a human being, not a specialized insect.
He does all that. And for him, hunting and pecking is efficient enough.
I know basic things like cpr, how and where to apply pressure to stop bleeding, signs of a stroke or hypothermia, you know, basic vital stuff to keep someone alive in case of emergency.
Similarly, I'd expect a doctor to be familiar with things such as "save as" or "print screen" if they used a computer every day.