Kevin and I talked about a lot of topics, but one topic that was of particular interest was getting information published in journals. As an active researcher Kevin has a laundry list of published articles to his credit, giving him keen knowledge of the process for publishing research in peer-reviewed journals. One thing that struck a chord with me was the effort and time required to get an article published. Apparently it can take multiple article revisions and upwards of a year to get an article accepted by a certain journals.

No one that’s been involved in the process would be shocked by this; not even me. I’ve heard this before from other people in my profession. The problem is that the model doesn’t work for informatics, automation and technology (IAT). The speed at which the field is evolving means that information is often obsolete by the time it hits the peer-reviewed journals.

The basic question is whether or not information about pharmacy IAT requires the same rigors as research aimed at the clinical side of pharmacy. Does a study of turnaround time during pharmacy distribution with carousel technology vs. robotics require the same intense scrutiny that a study looking at the use of an ACEI vs. an ARB in PWD and HTN would?  Not likely. While one could argue that the method of distribution may impact patient care it is unlikely that the impact would be worth little more than a friendly debatable among colleagues.

I browse the table of contents of many journals every week. In addition I subscribe to the MedInfoNow service, which alerts me to new literature articles based on my personalized search criteria. And what I see week after week is a lack of information in a field that is arguably the fastest growing pharmacy specialty in the profession. Can you name a pharmacy specialty that is growing faster than informatics? I can’t. Informatics residencies are springing up all over the country, I’m seeing more and more IAT related information in social media, the content for pharmacy informatics at the ASHP Midyear is increasing each year, and so on. Pharmacy informatics is no longer a topic that pharmacist don’t know about. It’s mainstream.

As pharmacy informatics gains in popularity, new ideas, experimentation, and tinkering will ultimately take place on a larger scale. Unfortunately most of us will never hear about it, or if we do the information will be so out of date that it won’t apply to current practice. We need a way to disseminate IAT information to the masses.

Two journals that provide IAT information in a timely manner are ComputerTalk for the Pharmacist and Pharmacy Purchasing & Products (PP&P). I read both. They both offer information regularly and provide worthwhile content for IAT. PP&P has become the de facto IAT journal by default. They pump out volumes of new, relevant content each month. Unfortunately both ComputerTalk for the Pharmacist and PP&P are considered ‘throw-aways’ and are clearly supported by industry advertising. I have no idea if that creates a conflict of interest or not. It would for journals publishing clinically relevant drug information, but I would argue that it’s probably not the case for IAT.

You might argue that JAMIA is what we’re looking for, but that journal is only published 6-7 times a year, is insanely expensive, is not pharmacy specific and contains some articles that are so granular that they rarely apply to current practice. While JAMIA is clearly worth reading if you have a subscription – which I don’t – it’s not quite what I think we need.

There are other journals similar to JAMIA, but you get the point.

During the conversation Kevin mentioned the possibility of using a post-publication review process similar to what the physics community is doing. Apparently this group has decided that getting the information in the hands of their colleagues is more important than the review process. Articles are published first, and then reviewed for content, appropriateness, rigor, etc. While one could point to potential problems with a system like this, I think it holds promise for something like Pharmacy IAT.

How about a wiki, you say? I’ve been harsh on things like Wikipedia because content is easily added, but not necessarily accurate. We all assume it is, but I wouldn’t want to use Wikipedia for drug information or patient care.  With that said it’s still a viable option. While not as rigorous as a peer-reviewed journal, it’s still a great way to compile information. Sounds like a winner, but then reality sets in. Who would curate such an effort? Who should have access? Limiting access for the purpose of control might be a solution, but this could potentially create a barrier to building content.  What type of information should be included and/or excluded, if any? Where would the information reside and who would own it? These are all good questions that should be answered, eventually.

My initial thought was that an organization like ASHP should support a Wiki for Automation and Pharmacy Information Technology (WAPIT – dot com already taken just in case you were wondering), but I quickly came to the realization that that would be a bad idea. ASHP is governed by rules that would eventually cause more harm than good. No, I think the effort would be best served by an individual or small group interested in advancing the field. It would have to be open source, and the content would have to be reviewed for gross oversight and inaccuracies. But who has the time? It would likely be a labor of love, full of late night frustration and long weekends. And even if someone decided to labor over something like this, finding people to add content would be difficult. Pharmacists as a whole are introverted and don’t like to put things out there for people to read. If you don’t believe me, just take a look at the number of pharmacists that blog or play in the social media arena compared to nurses or physicians. There’s quite a discrepancy.

What about all those academics? This should appeal to them, right? Wrong. When I asked Kevin about contributing to something like a WAPIT, he simply said “peer-reviewed journals are the currency of academia”, meaning he gets to keep his job for getting his research published in a peer-reviewed journal. Pushing content to a free wiki where the focus would be on providing information over recognition and career advancement doesn’t help them keep their jobs. It’s hard to compete with that.

Creating a repository for Pharmacy IAT information is sorely needed, but getting it done would give new meaning to the phrase “beating my head against the wall“.

I’ve read that good ideas are hard to come by, vision even harder and innovation rare. I don’t buy it. I believe innovation is difficult, but probably not for the reasons you might expect. On the other hand I don’t believe that ideas are hard to come by or that vision is rare.

I think ideas are like change in your pocket and you tend to collect more than you think. If you’re like me, and I believe most people are, you probably have several ideas every day about changing how something is done, how to make something better or what the next big thing should be. You know what I mean. All those moments throughout the day when you say something like “what if they…” or “why didn’t they…” or even “wouldn’t it be cool if …”. You know what I’m talking about, like “wouldn’t it be cool if they filled marshmallows with hot fudge”. Yes, yes it would.

Last week I was sitting at the kitchen table working when I happened to look out the window to see a busted sprinkler spewing water into the air. Bummer. My first thought wasn’t to jump up and fix it, although I did. No, my first thought was “why doesn’t someone make a sprinkler system that repairs itself”. That’s an idea. Realistic or not, it’s an idea. One could try to build a self-repairing sprinkler head if they really wanted to. Not sure how that would work, but that’s why God created engineers.

Anyway, I decided to do a little experiment where I kept track of all those “what-if moments” for a few days; turns out that I have between five and ten each day. Try it sometime. I bet you’ll find that you have a similar experience. Not all ideas are gems, of course. Some are pure garbage while some may be worth further investigation. That’s where vision comes in. If you can “see” how your idea fits into the world around you then I think you have vision. And I believe that most people know where their idea belongs, otherwise the idea wouldn’t have popped into their head. Yeah, roasted hot-fudge filled marshmallows would go real nice between two graham crackers.

The difficulty with ideas and vision comes when you try to turn them into reality. To be innovative reality requires that you turn an idea and vision into something tangible, and the problem with building something tangible is that you often have to rely on other people for help. Of course there are exceptions to every rule, i.e. small things that take off for no identifiable, reproducible reason – Facebook, Instagram, YouTube, etc – but in general you have to get other people to buy into your idea and vision to make it happen. And therein lies the problem.

Most people have their own idea about how the world should work and it doesn’t necessarily agree with yours (or mine). That’s how we end up with such variety in everything around us, from electronics to food, cars, clothes and so on. Variety is good, but not when it compromises good ideas and a solid vision.

Have you ever tried to explain something to someone only to look up and see that they’re not on the same page as you? Sure you have. Everyone has. Sometimes vision is difficult to explain or can’t be written down. And even if you manage to explain something in a manner that makes sense, people will often want to change the idea. I think this happens with most ideas because the idea makes sense to some, but not all. I see this all the time in my current job. Battles are often waged over the weirdest things.

I often wonder how much is lost over decisions made by committee. It’s difficult to say, but I certainly think it stymies the innovative process. How many average ideas have sprung from compromise? Too many, I fear. This must be where the saying “you can’t win every battle” came from. It’s true, you can’t win them all. Unfortunately every lost battle comes at a price to someone.

I think the days of mad scientists working alone in their labs are over, and that makes me a bit sad. Just because the process has evolved doesn’t mean it’s better.

It’s a strange world we live in.

However, the issue wouldn’t go away. A couple of weeks later it popped up again as a friend and colleague shot me an email asking why I hadn’t completed the on-line biographical nomination form and upload my Curriculum Vitae for a position on the SOPIT Executive Committee. I gave the canned response that I wasn’t interested and that type of thing wasn’t for me. But the seed had been planted. About a week later I logged into the ASHP website and proceeded to jump through all the hoops associated with running for one of the positions on the executive committee. You know, lots of questions about how you would change the world and make it a far better pharmacy friendly place to live.

Anyway, I was informed today via email that not only did I not get nominated for a position on the executive committee; I didn’t even make the cut to be included on the list of possible candidates. Ouch! Here’s the actual wording “The Section of Pharmacy Informatics and Technology’s Committee on Nominations met this month to develop a slate of candidates for the summer 2012 elections. We received many letters and nominations for the two offices of the Section. Unfortunately, we were not able to slate you for this year’s election. “ Doh!

I won’t lie, my ego took a hit. Even though I’m generally not well suited to sit on committees I thought this would be cool. Should have gone with my gut and ignored the email. Humility is a good thing, but sometimes being humbled stings a bit. Better to think you turned them down than the other way around.

I’ll eventually get over it. People are resilient that way. In the meantime I’m forming my own committee of which I will be the Executive Vice President; I’m not President material. Haven’t decided what the committee will do, but it must involve Diet Pepsi, popcorn and movies. If you’re interested in being on the committee let me know. Space is limited.

1. To be absolutely clear, this is a rant. Sometimes I rant to my wife, other times on paper. This time I felt compelled to throw it up here.
2. I’m a tablet PC fan, and this is my opinion. If you have an alternate opinion, that’s cool. If you want to talk about tablets with me, by all means let’s talk. I love it when people show me cool things they’ve done with their tablets. But if you want to argue with me about my opinion, fell free to stay away. People that want to counter my opinion with useless drivel tend to do nothing more than make me think less of them than I already do. And trust me when I say that I have a pretty low opinion of most people to start with. Not all people mind you, but many. It’s unfortunate I know, but society in general has done little to change my mind.

Ok, let’s begin ….

I enjoy reading articles about tablet PCs, but these day’s they’re not as easy to come by as you might think. The internet is mostly filled with articles about the iPad and Android tablets. Those are the sexy devices that all the consumers enjoy. I have a few non-windows tablets laying around the house myself, including an iPad, two Android tablets and an HP TouchPad. Even my wife uses two non-windows tablets these days: an iPad and a Samsung Galaxy 7” tablet. I understand the appeal of these devices. I get it, ok.

In an article over at Tech.pinions, Nathan Brookwoods presents a great summary of how I feel about the tablet industry today. Here’s the short of it: tablet PC’s are great for taking your desktop computing needs with you without giving up the tablet experience. He makes some great points in the article. He also has a couple of errors in the post. Of course, the iPad loving knuckleheads in the audience then proceeded to point them out in the comment section and argue why the iPad is just as “good” as a tablet PC. It makes me want to puke. It also makes me wonder if these people have ever used a tablet PC. I’m going to go out on a limb here and say that most people that use an iPad have never used a tablet PC as their primary computer. Trust me, it’s a safe limb to climb out on.

Reading through the comments of the article only cements the idea in my mind that people are irrational and don’t possess the ability to step back and look at things objectively. If you want to use an iPad be my guest. But please don’t compare it to the power of a full-blown operating system like Mac OS X or Windows 7/8. They are not the same thing. I see people all the time struggle to use iOS and Android tablets as a laptop replacement. It doesn’t work for most people. Why? They’re not designed to do the same thing. And if you can replace your laptop with an iPad or Android tablet, odds are you didn’t really need a laptop to start with. Hint: checking email doesn’t require an Intel^® Core™ i7 Processor and 8GB or RAM.

A moment of reflection. I’m looking at my laptop, a Lenovo T410s, and my Lenovo X201t tablet PC sitting right next to it on the couch and wondering if my iPad or my Samsung Galaxy tab could really take the place of either of these machines. The short answer is no, no they can’t.

On my laptop I have the following open:

• Google Chrome – Going back and forth between Twitter and personal and work related research – one, two, three….18 tabs open.
• MS Word with 3 documents  open that I’m working on for work
• MS Outlook – Email, gotta’ love it
• MS OneNote looking at some notes I took on my tablet
• MS Excel with a spreadsheet for some product enhancements for a product I’m working on
• PDF Annotator – I’m marking up a PDF
• Windows Media Player – Just listening to some music

And if I were to pick up my x201t it would look similar. In fact it usually does. These are work machines, and I can do all of this on my “tablet” without compromise, without leaving a screen, without worrying about this or that.  This is not artificially inflated. This is a typically Saturday morning sitting on the couch as my family slowly comes to life.

You can’t do all this, at the same time, on an iOS or Android tablet. Actually you can, but it would cause some angst; easier on an Android device, but still not something I would like to try. And if I wanted to watch a movie, which I frequently do while traveling for work, I simple log into Netflix and watch a movie. If I want to draw something or sketch out an idea, no problem. I simply open OneNote, or Autodesk SketchBook Express and do it. No big deal.

I often read through comments on articles like the one mentioned above just for the entertainment value, but once in a while it gets to me. People will argue that black is white if they think “white is better”. Even in the face of insurmountable facts. Please don’t take this to mean that I believe tablet PCs are perfect, because they aren’t. I have my fair share of issues with my machine. I recently installed Windows 8 Consumer Preview on my Lenovo x201t. It’s definitely a better tablet experience, but it’s still not perfect.

As much as I enjoy using tablet PCs I still reach for one of my other tablets – at the moment my favorite seems to be the HP TouchPad – when I’m watching TV and want to check my email, play a game or simply browse the web. But when I need to work, really work, there is no substitute for the “desktop” experience. Believe me, I’ve tried. And to get the desktop experience on a tablet you have to use a tablet PC. If you believe otherwise I honestly believe you’re kidding yourself.

I can’t force people to change their opinion, and I suppose deep down I don’t want them to, but I would ask that people stop making outlandish claims for the sake of argument. “Tis better to be silent and be thought a fool, than to speak and remove all doubt.” - Abraham Lincoln. I realize that I not remaining silent, but occasionally I have to do this or things will simply go down hill from here. 

I feel better. Rant over.

This morning (broke my rule about Sunday morning reading, Doh!) I read his latest post, Medical Experts and the American People. This is one time when I think he got it wrong. In the article Dr. Reece basically chastises evidence based medicine (EBM). “I say “presumably” because many patients or doctors do not necessarily buy the experts’ advice [i.e. evidence based recommendations] or follow instructions.” Uh-oh.

He continues the rant by quoting from March 31 Wall Street Journal article “The Rise of Medical Expertocracy”

“For patients and experts alike, there is a subjective core to every medical decision. The truth is that, despite many advances, much of medicine still exists in a gray zone where there is not one right answer. No one can say with certainty who will benefit by taking a certain drug and who will not. Nor can we say with certainty what impact a medical condition will have on someone’s life or how they might experience a treatment’s side effects. The path to maintaining or regaining health is not the same for everyone; our preferences really do matter.”

Dr. Reece finishes by saying “I agree with these observations and conclusions. In the end, there is usually no single right answer to treating an individual, and patients, in conjunction with their doctors, have the right to choose what to do. Despite the rise of medical experts, armed with vast accumulations of data, there still exists no single answer to most medical problems.” 

A couple of comments about this. First and foremost I agree that patients, in conjunction with their physician, have the right to choose their course. But that doesn’t preclude the use of EBM. Second, EBM doesn’t mean letting someone else make a decision for you. It is designed to present you with the latest evidence to give you the information you need to make the best decision possible. Would you really want to do something that has been shown to be detrimental, or miss out on something just because you were too stubborn to look at EBM? If you said yes, it’s an injustice to your patient.

Sometimes there is a single best answer to a medical problem and that’s where EBM shines. I have to laugh when a physician screams that they don’t need EBM telling them what to do and that every single patient is different, only to turn around and write for the exact same medications for the same problems over and over again. How is that different? Did they treat every patient differently? I don’t know. If you use HCTZ for every patient you have with primary HTN, you haven’t exactly gone out of your way to individualize them now have you.

When I used to works nights as a pharmacist in the hospital I could tell you exactly what type of admissions I was going to see and what my technician and I would be doing based on which physicians were in the ED. Prior to starting my shift I’d wander down to the ED and see who was working. That gave me a mental head start for what my night was going to be like. I knew before I started work what medications I’d need on hand, what type of IV load I was going to have, whether or not I’d need to do a lot of vancomycin or gentamycin kinetics, and so on. Why? Because they treated every patient that walked in the door exactly the same way, that’s why. There was no “every patient is different approach”.

Would you want your physician deciding what TB meds to use on you if you had a newly diagnosed case of active TB instead of following the most recent guidelines? You’re a fool if you do. That’s a good way to develop a nice case of multi-drug resistant TB that could make your life miserable down the road.

Ever see a post-op CABG order set? Yeah, those are developed based on EBM and contain about 30 different medications. Any physician that says they’d rather write one of those by hand based on their own ‘opinion’ after consulting with their patient is a liar.

Would you want your physician to think about what to do with you if you were dragged into an ED with sepsis? Heck no. I’d want them start fluids and throw a host of antibiotics at me. Which antibiotics? I’m glad you asked. There are guidelines with laundry lists of recommended antibiotics. They’re based on worst case scenarios and the belief that you’d rather err on the side of overly aggressive than not aggressive enough. Do you know why? Because studies have shown that you need to start fluids and antibiotics ASAP or your chances of survival goes down. Crud, start them in the ambulance if you’ve got me back there. No need to wait for the physician to mull it over with me.

Any pharmacist in the audience know how to treat a 65 year old patient admitted to the hospital with community acquire pneumonia? Of course you do. There are some great guidelines out there put together by the IDSA or other well respected professional organization. And I will guarantee you that those are the exact same guidelines followed by thousands of physicians in the U.S. Does it make them any less of a physician because they peeked at the guidelines for treatment recommendations? Uh, no.

The bottom line is this, EBM is not designed to take your control away. It’s there to make you a better practitioner. Does every patient require the same approach? Probably not, but to believe that every patient is so different that each and every one of them requires a new, unique set of treatment options is preposterous.

During my career I’ve probably interacted with more than a hundred physicians; some good, some bad. With that said, the ones that are the hardest to work with and make things hardest on the pharmacists and nurses are the ones that believe their opinion outweighs the years of research and study done by those before them.

I want a physician that not only has an opinion and years of experience, but one that doesn’t ignore EBM because their ego won’t allow it. We should all have opinions about things, and we should all strive to change practice if we think something is better, but we should not ignore best practice simply for the sake of railing against the system.

For whatever reason I decided to take a long hard look at my note taking needs this week. I’ve been rather irritable lately and found myself nitpicking many of the cons associated with using a tablet PC for taking notes that I previously overlooked. The shortcoming of using a tablet PC are obvious: battery life, “boot time”, size and the mother of all….you can’t take notes on a tablet of any kind when it’s turned off, which has been a real issue for me while traveling.

Before going further I should explain why I take notes. After all a lot of people take notes. I still have notes from pharmacy school even though I’ve never looked through them. Notes are only valuable if one returns to them for information, which I typically don’t. For me taking notes is about recording my ideas. Several years ago my brother, Robert recommended that I start putting my ideas on paper. He’s been doing it for a long time. My brother is a sharp guy and his recommendation made a lot of sense, so I started using Mead Composition Books to record my ideas about pharmacy, computers, gadgets, etc. I’ve since moved on to Moleskin Notebooks, but I use them the same way. This was all before I discovered the joys of using a tablet PC to record my thoughts. The advantages are obvious as the tablet PC allows me to file, sort and search my thoughts much more efficiently. I can add links to other files or websites, photos, videos, audio recording, etc. There really are few things you can’t do with a computer. Throw in the fact that I can sync my OneNote Notebooks and my Evernote collection across all my devices and it becomes a no-brainer. Until this week that is.

As stated previously I’ve been a bit frustrated with using my tablet and gone back to my Molesking Notebooks and a JetStream pen; my favorite pen in the world. And before all you iPad-toting zealots start screaming about using the iPad for taking notes, remember that I’ve been down that road. Also tried using an couple of Android tablets. It simply doesn’t work for me. Those devices are not designed for taking notes with a pen. None of them are with perhaps the exception of the Galaxy Note 10.1-inch tablet, which I haven’t tried yet. Consumer tablets from Apple, Samsung, Motorola, etc. have changed the world we live in, but in my opinion they still don’t replace a tablet PC for taking notes, not to mention that they don’t even come close to good old fashioned pen and paper for that activity. If you think otherwise you’re delusional and should stop reading now and move on. Sorry, I digress.

Back to my note taking crisis.

Monday morning of this week I decided to keep a notebook and pen with me throughout all my activities. Even as I sit here typing this, my notebook is readily available. An idea pops into my head, I open the notebook and sketch it out. The notebook is instant on, never has to be charged, weighs less than my wallet, doesn’t have to be powered on or off during taxi, landings and take-offs, never has to be updated or rebooted, doesn’t cause eye strain after 10 hours of looking at it, and so on. I think I’ve recorded more ideas on paper this week than the rest of this year working from my tablet. Why? Because it’s quick and easy. The process of picking up the notebook and writing something down doesn’t detract from what I’m doing on the computer. You all know what I’m talking about. You click on a link and end up spending two hours on something totally unrelated to what you’re working on. The notebook offers no links, although that would be cool.

Sometimes the simple things really are best. Pen and paper are currently my best tools for recording ideas. And honestly, until a tablet computer from any company can equal their ease and flexibility they will remain my tool of choice.

Grrr! I knew it. Something totally ridiculous, misleading and meaningless. What was I thinking? Why do I torture myself this way? One can only speculate.

The link led me to the following article: Heart Attack Survivor Says An iPad Helped Save His Life 

“…he remembered having his iPad in his bag. The tablet was a tool he had just gotten and was just beginning to use in his practice of medicine.

In seconds, he brought up the Mayo Clinic’s application to access patient electronic medical records so as to look at McMonigle’s EKG from his past heart scare. The doctors compared it to the new heart rhythms, which confirmed their suspicions that McMonigle was having an acute heart attack.“

I wasn’t surprised, but was certainly disappointed. Based on the stream of Tweets and title of the article I thought for sure the iPad grew legs and pulled the man from a fire. Alas, that wasn’t the case at all. Do I really need to mention that the man had the clinical acumen to diagnose his own heart attack, or that he was standing in a room full of physicians? The iPad had nearly nothing to do with saving the mans life. Why not credit the highly trained healthcare professionals for acting quickly, or the healthcare system that had the foresight to build an EHR that lends itself to mobile access, or the millions of dollars worth of advanced healthcare technology that, oh I don’t know, was used to actually save the man’s life. Sheez.

Here’s an equivalent article for you: Heart Attack Survivor Says BlueTooth Mouse Helped Save His Life 

“…he remembered having his BlueTooth Mouse in his bag. The mouse was a tool he had just gotten and was just beginning to use in his practice of medicine. 

In seconds, he brought up the Mayo Clinic’s application to access patient electronic medical records so as to look at McMonigle’s EKG from his past heart scare. The doctors compared it to the new heart rhythms, which confirmed their suspicions that McMonigle was having an acute heart attack.“

Sounds ridiculous, right? It’s. The. Same. Concept. This is what happens when you get a bunch of people together to write a story armed with IQ’s no bigger than the temperature on a hot summer day in the Central Valley of California. This type of hype irritates me more than you can imagine. Focusing on some small piece of consumer technology – whether Apple, Android or Windows – in a story like this goes off the must-have-been-a-slow-news-day o’meter. And people eat it up.

News worthy would have been if the guy pulled an augmented reality device from his bag, injected a few nanobots into the guy and cleared the blockage and repaired the vessel on the spot. That’s technology worth writing about.

That’s it, no more early Sunday morning reading for me. I’m sleeping in.

I recommended that we use the pharmacy specific lingo, but I was told no because it wasn’t the industry standard. I found that quite interesting because we build products for pharmacy, i.e. that is the industry we’re in. However, the terminology used for this particular process is different outside the pharmacy world. Still with me? Good.

So, the question becomes does one conform to the terminology in the market segment you’re in, i.e. pharmacy, or do you ignore the pharmacy terminology and go with the “standard”? My gut reaction would be to go with the standard – after all I preach standardization all the time – however, if one does that you end up talking to pharmacy people that have no idea what you mean. You know, everyone has that deer in the headlights look with everyone standing around wondering what the heck is going on. And to top it off, no one asks for clarification because they’re afraid it might make them look stupid. We’ve all been there. I know I have.

So, based on what I just said above I think you have to conform to the industry you’re in. In other words, use the pharmacy terminology, standard or not.

One thing is for certain, if you’re waiting for the right moment, the moment will never come. Decisions don’t need to be right or wrong, they simply need to be made. Heaven forbid you make a bad call on something. I seriously doubt anyone has gone through life mistake free. If you never make a mistake you’re not trying hard enough in my opinion. Heck, I’d go as far as to say that some of the most valuable lessons I’ve learned have been from my failures. Sure, the failures sting a little, but that’s what helps one learn from the process.

I believe fear is the cornerstone of indecisiveness; fear of making the wrong decision. Choosing to not make a decision is, in itself, a decision. Unfortunately it’s a decision that people repeat time and time again without learning from the mistake of not choosing. The only way to learn to make good decisions is through the experience gained from making bad decisions. Kind of a circular argument, I know. Go figure.

According to Albert  Camus “life is the sum of all your choices.” So what does that say about your life if you don’t make any decisions? Not much.

As Staff Sergeant Nantz so eloquently put it in the movie Battle Los Angeles, “You can go right. You can go left. I don’t give a damn. Just make a decision”.

I Googled “epatient”, and here’s what I found: “e-Patients are health consumers who use the Internet to gather information about a medical condition of particular interest to them, and who use electronic communication tools in coping with medical conditions The term encompasses both those who seek online guidance for their own ailments and the friends and family members who go online on their behalf. e-Patients report two effects of their online health research: “better health information and services, and different (but not always better) relationships with their doctors.”” This definition comes from Wikipedia. I’m not a big fan of Wikipedia, but in this case it seems appropriate.

Here are some thoughts on the e-patient movement:

• It assumes free time – If you don’t already have a working knowledge of the heathcare system, diagnoses, use of medications, etc, then it can take you quite a bit of time to figure it out. Many families have their hands full trying to make a living and survive in this crazy world without having to worry about whether or not they’re getting proper care.
• Assumes access to information – Information on disease states and treatment options is found online, in journals and books, long discussions with your healthcare provider, etc.
• Assumes intelligence – Is it wrong to assume that the “average” person may not have the skill set necessary to keep up with their own health care? Some of this stuff gets complicated. Healthcare providers spend years in school plus years of training to do this stuff. If the average person can effectively manage their care, why the heck are we spending all this time, energy and money on training doctors, nurses and pharmacists? Shouldn’t the system be designed for the lowest common denominator? This isn’t a shot at those without PhD’s, it’s a legitimate concern. I consider myself a fairly intelligent guy, but I don’t think I’d try to build a nuclear submarine from some manuals and an internet search. Know what I mean?
• Assumes access to not only computers, but the internet – My girls go to school with kids that don’t have a computer at home, much less access to the internet. Don’t even get me started on the idea behind mHealth.
• Creates more silos; those that have the time, energy and resources to make sure they’re getting good care, and those that don’t. Many sick people simply want to be taken care of, and I think that is appropriate. We’re not fixing a car, we’re fixing people.

It’s always good to be an active participant in your care, but it shouldn’t reach a point where the care becomes substandard if you can’t. What if the e-patient becomes the “normal” patient? Will those that can’t manage their own health fall through the cracks and receive worse care? Probably. I’ve already experienced this while working closely with chronically ill family members; some with end-stage diseases. If you stay on top of things you get better care. If not, you receive worse care.

Should we really be developing a system that encourages people to provide their own care because it’s better than the care the system provides, or should we build a system that provides better care for every patient? With available resources we can’t do both. Build a better healthcare system. Think about it.