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Annual Oration of 2005

Old Dog, New Tricks

Orator: B. Dale Magee, M.D., M.S.

Synopsis of Oration:

Dr. Magee believes there has never been a better time to practice medicine with the tools of diagnosis and treatment being better than ever before. He recounts medical anecdotes of two uncles. One who was 59 in 1969, lived an active life, felt unwell after a handball game and suddenly died of his first heart attack. Another uncle was 59 in 1981, when he felt unwell but survived after a coronary angiogram and bypass surgery. He lived another 23 years, accumulating additional medical problems and additional specialist physicians. The 23 years of survival illustrate the increasingly complex nature of health care and its shift toward chronic illness.

However, increasing complexity results in overwork of doctors and a drop in their morale. Patients are being seen more often but the time allotted for a visit is only 12-18 minutes. Half of visits for patients over 45 involve chronic care. If physicians were to deliver all recommended preventive medicine there would be no time left for actual problems and so preventive medicine suffers. More powerful drugs are used more often and studies have shown increasing disparity between prescribed medication and those actually taken. New medications may also be prescribed inappropriately. Care is more dispersed and communications between the primary physician and specialists has suffered as has information transfer from outpatient services.

Returning to the story of his second uncle, Dr. Magee reveals that he had received exemplary care at a Veterans Hospital which he attributes in large part to the institution in the 1990s of computerized records. Dr. Magee believes the electronic medical record is the most important advance in health care in the last one hundred years. These records are legible, accessible, and organized. They contain drug checkers and can track orders which could prevent up to 80% of inappropriate drug prescribing. The value of such records extend beyond current usage allowing, for instance, a patient to carry his complete record in a keychain sized device or even allotting each patient an individual webpage which could serve as a center for communication and scheduling.

There are, however, barriers to adoption of electronic records such as a fear of changing current workflow, the time required to learn a new system, and an unstable vendor pool which hinders record system compatibility. The expectation is that not everyone will change now. There will be early adopters who set the pace for eventual expansion. Fortunately, age does not determine the early adopters and the "old dogs" among us are just as likely to embrace innovation.

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