I have always had ectopic brains. Those are the external resources we use to reference stuff that physicians need to know. As a resident, it was pockets full of manuals – the Washington Manual, Handbook of Pediatrics, etc.

Frankly, I always had trouble remembering a lot of the micro-minutiae that come with practicing medicine. My brain works well at puzzling out stuff and putting together a bunch of obscure stuff to dig out a diagnosis, not so well at remembering “the list of drugs that can cause thrombocytopenia.”

If I ran into a case of thrombocytopenia, instead of remembering the top ten drugs that cause this, I looked it up. Knowing my limits, there were always specialists available to consult if it didn’t fit conveniently in my pocket.

Given enough time, it didn’t take a lot to become a world expert on something obscure by simply reading all the existing literature on the subject, and then calling the one or two physicians in the country who had actually treated the cases that did exist.

Technology Made My Life Easier

The Internet has changed all that. Instead of having to keep a library of books in pockets and bigger books in an office library, we have references galore by using any convenient search engine. And I’m good at it. I even give a talk on how to do it. Having given the talk, I’m impressed with how well I do it, and how much even some of my younger colleagues can learn from this old guy.

Having used an electronic medical record (EMR), and bought it simply because I needed to be able to read my own notes, I discovered the joys of CDS. That’s Clinical Decision Support. I built templates, borrowed a lot, and imbued my templates with all the minutiae that otherwise would require a quick look into a manual (or a current standards of care page on a reliable website).

When beta blockers suddenly became indicated for CHF, not contraindicated, I wrote that into my template, along with links to the pertinent article, in case my ornery brain couldn’t compute what had been contraindicated was now strongly indicated.

My EMR served as my ectopic brain, allowing me to rely on it to tell me the top three antibiotics for treatment of outpatient pneumonia, and calculate the score (if needed) to tell me whether my patient was really sick enough to be inpatient. Mnemonics and all the little memory games to remember the bones of the hand and all that stuff became live links to diagrams to the Internet or my intranet, which also contained copies of all my patient education materials, with all my personal speeches on the daily stuff we need to educate patients on.

Need to lecture patients on IBS? “Here, let me have you read this, and I’ll be back in a few minutes to see if you have any questions.” Pretty darn efficient.

The Next Big Game-Changer: Telemedicine

What’s next? Why, telemedicine! No longer will I have to rack my brain about the obscure or wonder what the heck that rash is.

There are websites that allow you to consult the entire clinical world simply by posting the pertinent clinical details (anonymized, of course) onto a protected “physicians only” space, and have knowledgeable physicians from the entire planet weighing in on that funny looking thing!

Even better, certain specialists are now available to see your patients live (assuming you have the technology), allowing them to see those specialists from the comfort of your own exam room with a few inexpensive gizmos instead of waiting weeks for an appointment and traveling hours away to the tertiary care facility nearest you.

I wish the technology had existed 30 years ago, I might have chosen a completely different location to practice (hello rural Pennsylvania!).

What’s next? Will Pennsylvania get its telemedicine act together in time?