Skills in Search As Valuable as Memorization

Neils’ article about Unrealistic Expectations about Clinical Decision Support made me think of how important the ability to know where to find the information can be in so many different situations. In fact, memorization of where to search might be more valuable and useful than strict memorization of everything.

The core point is that with very rare exception, the human mind can only store and recall so much information. However, if you only have to remember where to find a certain piece of information, it’s much easier to remember. For example, many of my readers probably don’t realize that I have a network of TV blogs. I get a lot of credit on those websites for listing out the music for those shows. Funny thing is that I’m not all that good at identifying songs. However, I am great at searching and finding the information.

Why can’t we accept this from doctors? Why do we expect that doctors should know everything as opposed to accepting that they don’t know everything, but they know where to find out more? Many actually can accept this.

Of course, many people might appropriately ask the question, “If my doctor’s just going to look up the information, why don’t I just look it up myself?”

There are quite a few reasons why it’s not the same. Let me just give one of them. While Doctors don’t know everything, they have been trained to identify the relevant information. Understanding what’s relevant turns out to be incredibly valuable when trying to solve a problem.

How about an example for comparison sake. Many Windows users are quite familiar with what’s affectionately called the Windows “Blue Screen of Death.” To the untrained eye, the blue screen of death is a daunting screen that provides an information overload of error messages of what went wrong your computer. To an IT person like myself, I can quickly identify the 1 or 2 lines that are actually relevant to the problem and find a possible solution.

While certainly not a perfect comparison, I think the skills that a trained doctor uses to identify a medical issue are similar to the above scenario. Funny thing is that no one would have any issue with me doing a search for how to solve the problem the blue screen of death identifies. However, many are uncomfortable with the idea of their doctor doing a similar search.

This isn’t to say that patients shouldn’t participate in their own care. That’s a related, but different topic. However, I echo Neil’s call for patients to be more accepting of doctors who use clinical decision support and other tools that help provide better care. Not to mention his call for doctors to not be afraid to admit when they don’t know everything, but that they have the tools, resources and skills to provide great patient care.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

9 Comments

  • Probably the overloaded blue screen with multiple error messages is a good analogy for some of the doc’s memory details. You see the listing and know what is important. Doc’s have similar functions in analyzing. That is what you are referring to–analysis. Memory is different, but in the human memory (mimicked by the better search engines) recall of detail (memory) and analysis seem to be running on parallel processors.

    Unfortunately, EMRs can obscure detail as well as present nicely categorized groups that aid the speed of finding the detail.

    I use Allscripts Enterprise daily. If I free text the patient’s story, I cannot search those details by machine—only by visually looking at the free text portions.

    The biggest, most easily forgotten details in the middle of the night are things like allergies. If the patient was given a drug that caused an allergic reaction by that doc, then it is remembered. If it was an older allergy not witnessed by that doc, it is less likely to be recalled.

    Electronic storage is not as quick as human memory, but the details are held with greater accuracy in some parts. Formulating the search and typing it into the keyboard takes time, in that period of time I can remember a lot of details—but perhaps not all the right info. I need both to be honest.

    Having access to my own small office details occasionally allowed better decisions from an off hours question. I could even turn the last physical exam into a pdf file and email it to the ER doc.

  • Funny, I remember on a busy workday, having my front staff PDF convert some records to fax off to a hospital resident who was admitting a patient I had seen a month prior. It was all sent off within 10 minutes.

  • We patients should be looking it up ourselves. In the ideal world, the patient and the doctor are supposed to be a team. The patient takes an active role in monitoring their own health and making sure the doctor addresses the needs he or she finds important. The doctor brings expert knowledge and the ability to prescribe medication, refer to specialists, and so on.

    EMRs have many roles in this model, but one role it should take is to help with the rote memorization, summarizing, reminding and sifting through the mountains of information that is hard to remember and get right every time, such as drug interactions and allergies. Let the EMR do the grunt checking and leave the high-level decision making to the doctor-patient team.

    Great topic, lots of passionate responses.

  • DocJim,
    Great comments. Analysis would be a better description than just memorization and it is quite different. I’m going to use your term, now. Although, I will say that it requires good memory to provide great analysis. It’s just memorizing different details than just regurgitating info.

    The above post was really looking at memory/analysis from a clinical decision support perspective. You bring up another interesting perspective when you talk about how the EMR displays the past medical history, past visits, allergies, etc. This can definitely help or hurt the doctors analysis of the information depending on how the EMR is designed.

    Dr. West,
    So you remember the fax. Do you remember anything on the fax?

    Steven,
    Yes, I put the disclaimer about patient involvement in the post above. No doubt, they can, should and will be participating in the process as well. In fact, it underscores the fact that doctors can’t and shouldn’t have everything memorized. Patients need to be understanding if their doctor needs to utilize tools to give them better care.

  • Apixio has addressed this need, making search of clinical information as simple as using Google, Yahoo, or Bing. It may be even more powerful, since we use semantic mapping (instead of just lexical), so “DM” and “diabetes”, or “angina pectoris” comes up for a search on “chest pain”, and build associated terminologies based on processing medical journals, research, and clinical records.

    It may be that next advancement in EHR you’ve been seeking, so please stop by our website (http://www.apixio.com) and see for yourself. The first user/provider in an organization is free, and there’s trial period for multi-user organizations.

  • Sorry about wrong edit on last post: “DM” (a common medical annotation) and “diabetes” are associated together, but not with “chest pain”. That was a proof reading human error.

  • Apixio Ambassador,
    How do you see Apixio being implemented? Who will pay for the capabilities that it offers? Are you planning to integrate it with a bunch of EHR and HIE vendors?

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