I'm a student doctor with a CS undergrad. I'm constantly gobsmacked by how horrible the computer systems doctors are forced to use are. They're pretty much abusive to use.

The hours and hours of physician time that are thrown away into mindless box-ticking, copy-pasting, button-pushing, and general head-banging is astounding.

If doctors are resistant to new IT hurdles it is, at least in part, because they're already faced with a decathlon-esque ritual to achieve their basic day's work.

Yep. Never blame users for raging at the system until you understand the system as well as they do. Techies have it easy: they only have one job and that’s all they ever do. It looks very different from the other side.

(Protip: The key to delivering successful software is not to learn programming, it is to learn your users.)

(Oh, and good luck with your medical studies; world needs good Renaissance [Wo]Men now more than ever.)

> (Oh, and good luck with your medical studies; world needs good Renaissance [Wo]Men now more than ever.)

Why now more than ever?

Growing complexity. Struggling scalability. Overspecialization. Balkanization. Failures of accountability.

OP’s firsthand observation on the awful state of programmer-produced medical software, the original linked article, and notoriously lethal software disasters such as Therac-25 provide frightening cases in point. These things are not accidents. Programmers who only know how to program are as much use as managers who only know how to manage. And this world has far too many of both.

Look, any idiot can hack teh codez. Learning the problem domain; that’s the hard part. It is also the critical core of the job. Because if you don’t/won’t/can’t understand the problem, how do you possibly expect to solve it?

Especially when that problem space is something as vast, complicated, and utterly unforgiving as millions of people’s healthcare.

I've never seen a programmer produced medical system.

Do you realize these systems are designed by respected doctors and product managers? They tell the programmers exactly what to do. When something vague comes up the product manager talks to his stakeholders and decides how to proceed. When the project is done the doctor/project manager group go over everything and make changes.

They decide things like how it looks is not as important as making sure you checkmark this section if you need to.

The priority is on reducing errors never on making the experience better for the computer operator (you).

This is an interesting point.

In fact the few medical IT systems I've seen that were actually built by doctors - that meaning doctors who code actually coded these systems themselves - are among the nicest (and most easy to use in a non-insane, secure, reasonable way) systems I've seen.

I think the important difference here is that it's very hard to "design" software if you are a doctor who knows a lot about medicine, and your existing paper processes, but know very little about software. It is important to understand the medium (software) as well as the domain (medicine) to build the right product.

Yup. In an ideal world, all systems would be built by domain experts who are trained to program.

I cut my teeth as a self-taught scripter/automator before going professional and eventually becoming a writer/educator myself, so I’ve seen plenty of every combination (and produced all of them too;). And I would much rather teach professional doctors how to make their own solutions than teach professional programmers how to write software for doctors. Because one of these audiences has a massive self-interest in getting a product that also works for themselves, while the other satisfied in taking a paycheck while ticking some boxes†.

That is to say; Incentivization is Everything.

--

† Which is not to say you don’t need—and want—formally-educated full-time developers in the mix as well; because good ones bring important transferable experience and insight into the more abstract aspects of system development like scalability and security. And yes, there are great devs out there who understand it is Muhammad’s job to go to the mountain, and not vice-versa. But damn, is it hard to find ’em.

“Do you realize these systems are designed by respected doctors and product managers? They tell the programmers exactly what to do.”

And here, in a nutshell, is EVERYTHING wrong in modern software development.

Doctors are NOT programmers. If they were, they wouldn’t need to hire programmers: they’d write the solution themselves!

Doctors are the domain experts. They understand medicine, and procedures in its current practice, and the reasons why things are done the way they are.

Conversely, the programmers’ job is not to write code. Any monkey can do that. It is to learn the problem space; to extract from the domain experts sufficient knowledge and insight to understand those procedures and why they are as they are for themselves. And then, starting from there, synthesize a new solution that does it all better.

And the PMs’ job is to mediate that learning process; to ensure both parties understand these objectives and keep them on track; and otherwise keep the hell out their way.

Whereas current industry practice is for programmers to sit with their thumbs up their asses, expecting others to tell them exactly what to do so they don’t have to learn, while PMs micromanage all the minutae so never have to take responsibility for the house itself burning down.

This is like civilian government telling military how to fight their war (e.g. Iraq War, 2003…2???), or the “Official European Joke” about Heaven and Hell. And not only are in the Hell part, the Programmers and PMs—who are supposed to be the highly-paid professional problem solvers here—really seem to believe that this hell we’re in is “How Things Should Be”; and thus only serve to multiply those problems instead.

..

FFS, I eventually got so sick of it all that I taught myself how to program (ugh), just so I wouldn’t have to go through all these useless spanners any more.

And, it pains me to say, software development is the first (and still only) career in my half-century of life where I’ve NOT felt crippled with Impostor Syndrome. Because the impostor, I realized, was everyone else.

> And, it pains me to say, software development is the first (and still only) career in my half-century of life where I’ve NOT felt crippled with Impostor Syndrome. Because the impostor, I realized, was everyone else.

Can you expand on this?

I think that describes any enterprise software.

Likely at go-live/vendor selection, nobody wanted to revolutionize things in a way that could only be done on computer.

The successful vendor will be the one that can « make all of your paper stuff look/function/feel the same way on a computer ».

This minimizes training, development and changing the workflow you used for 20 years. Which checks every department’s checkboxes.

So you end up with the worst aspects of paper, with few of the benefits of technology.

does this have anything to do with Epic systems software, in your opinion?

It may seem so, but I’ve done security consulting work for 10+ of the largest hospital chains and insurance providers in the country and I can assure you it isn’t an exception. Doctors don’t care about HIPAA (“that’s legal’s job”). They don’t care about the company’s finances (unless it’s a small private practice, “that’s the accountant’s job”).

Some of the complexity is caused by the software itself being complex, yes, but that’s not what I’m talking about. In every organization I have worked with, doctors were always the biggest obstacle to even doing something as simple as requiring them to carry around a badge for physical access to the building. As a group, they are very resistant to anything that might add an extra step to their workflow. And yes, everyone hates and is resistant to stuff being added to their workflow, but I find most people are amenable to it as long as it’s a small interruption and it’s for a good reason (security). Doctors generally don’t have that attitude, though.

Sounds like someone has it in for doctors.

I worked in healthcare IT for years, before than going to medical school, and now in residency. My experience really does not match yours.

As mentioned earlier in the thread, I will agree that doctors in general are quite resistant to technology because they have been fucked over by implementations that are more concerned with billing and regulatory than either better patient care or improving physician quality of life/workload.

Most medical facilities use badges for access. I think what you’re calling resistance is increased scrutiny, something you might not be used to dealing with in other fields.

Based on your sweeping generalizations tinged with bitterness I can only imagine most doctors that have to work with you professionally are going to be a bit on edge. The reaction you’re getting from all these physicians you’re working with is probably related to what I can only imagine is a shitty attitude.

Also in security for a long time, spending a lot of that with hospitals and healthcare organizations. My experience matches the parents. Your points are very valid but doctors can definitely be dicks as well.

Why you are resistant is important but you must follow the rules. Bad things beyond your imagination will happen if you click on that email link. The increased scrutiny allows for better patient tracking and care. That needs to be the priority.

Regulatory paperwork and billing are the reason why you are putting in information into the computer. Without these the medical centre closes. Getting the correct information to that department is part of the role.

The better approach would be to automatically filter email containing dangerous link, or automatically prevent whatever dangerous thing that happen when that link is clicked. Is it hard ? Sure, the goal is to maintain security without creating additional burden to the user.