Sunday, July 08, 2012

Dr. Larry Weed is The Oracle: Medical Records Should Guide and Teach!

Dr. Larry Weed was an amazing visionary physician.  Let me start by summarizing what he started saying in the 1960s:  "We need to better organize our records, better utilize paramedical personnel and appropriately use computers" - over 40 years later, and we still haven't followed his advice very well!  But we know it's true more than ever now, and we better start moving in that direction quickly!

Thanks to the internet, much of his original work exists, and it should be mandatory reading (and viewing) by anyone developing healthcare IT software or trying to change the system in any way.  Here are some of his papers:

  • Medical Records that Guide and Teach: His original 1968 paper in the NEJM explained the Problem-Oriented Medical Record (POMR) - which has since become the standard of documentation across the globe.   NOTE: Unfortunately, this system has often been incorrectly thought to mean the whole note should be in SOAP format (Subjective, Objective, Assessment, Plan) vs. having a SOAP component for each individual problem.  The result is that many notes are harder to create and read since they don't group relevant information together.  
  • Managing Medicine: His 1983 book which: "Contains the best of previously-published materials on Problem-Oriented Medical Records, and explains the Knowledge Couplers which have occupied Dr. Weed up to the year 2000. Much of this material is transcribed from lectures and conversations, so it preserves the candid tone, energy, and eloquence of Dr. Weed that can usually only be experienced in person or on videotape. Illustrated, with highlights captioned throughout." (per Amazon description).
  • Interview with Dr. Weed: A 2009 article written by a former student who says, "We discussed when he first was alerted to the nonscientific approach clinicians use to make decisions on patients. The rest of the interview time was spent with Dr Weed teaching me about the solution that he has spent the last 30 years designing and implementing."
  • Medicine in Denial (2011) According to Dr. George Lundberg's commentary, "In 267 pages, they sharply dissect virtually every sphere of medical education and medical practice. The tenet is familiar; the need to couple patient data with medical knowledge. This is not just a critical rant; it is a detailed "how to" fix the broken system.  Specifics such as "Changing medical education from a knowledge-based to a skills-based approach" and "Information processing, clinical judgment, and the two stages of decision-making" are good examples of the original 1970s premise still awaiting mass application in this century."  You can get a PDF overview here.
  • Other: "Medical Records, Patient Care and Medical Education" (1964), his first paper on the topic, and in a later paper he explains, "The Problem-Oriented System, Problem-Knowledge Coupling, and Clinical Decision Making" (1989).

Finally, I especially enjoyed this video of his 1971 Grand Rounds at Emory University (see below).  Some key takeaways from his presentation include:

  • Physicians need to be guidance systems, not oracles.  
  • The medical record provides the data needed to be a successful guidance system, and is critical for the best Education, Care and Research. 
  • Every patient and their problems are unique - just like there are 88 keys on the piano, but millions of symphonies can be played.  
  • Treating a sick patient is like a Chess game... you make your move, Nature plays her move, and then back to you.

1 comment:

  1. Thanks Lyle. I didn't fully "get" Larry Weed from reading his articles and Medicine in Denial. The tone, humor and candor in the 1971 video you provided closed the gap.