I was working for an EHR (electronic health records) software company a few years ago, and we had a presentation by a doctor. He was around 60-70 years old, and he was talking about his experience with our EHR.

He said "before EHR, I would look at the patient while they talked and my hand wrote on a piece of paper. Now, I'm listening to them while typing into a computer. I used to have at least one patient cry a day, now I can't remember when someone last cried."

Doctors know it's feels crap, it feels crap for them too, but they do it because it saves them a bunch of hours and mistakes every single day. We need a better EHR experience, though.

Dude needs a tablet, right?

> I have also literally had my doctor google my symptoms right then and there, and the “I could have done that” feeling just doesn’t build confidence. Clearly it’s through the filter of his knowledge but still feels wrong.

That's an interesting point, because I often google people's computer error messages in front of them, quickly determine the solution, and fix their problem.

I have the same experience as you watching a doctor do that, but from the inside this feels like a straightforward and easy way to get the information I need. I never quite thought about how it must look to someone on the outside.

I’m not convinced a doctor’s knowledge is stronger than my ability to read papers and evaluate statistical evidence for niche cases though.

In my experience, for most general practitioners, it's not!

There are specialists for a reason though. But I've found that YOU need to be able to do the work to get the referral and make the diagnoses.

Interestingly though, I had a family practice MD early on in my medical process that had a hunch, long before I suspected I had what he thought I did. (i.e. before I was able to steer the conversation to heavily emphasize certain symptoms after I'd pretty much figured out what I had and needed some diagnostics to confirm.) He just knew... Alas, the test came back negative, and he got roped into other endeavors before retiring. He was brilliant though, he had a PhD in epidemiology as well as an MD. (He even saw one of the very last smallpox cases in the wild.) Much later on, and several doctors later, we finally got that diagnosis right. For one doctor, I had to walk him through the results of the test before he finally put it together.... pretty unbelieveable, and there's no hope for the average patient in that scenario.

One thing that a lot of people without familiarity in medicine as an industry, the residency match process, etc. don't realize, is that family medicine/GP is the least competitive field. If you don't match into any residency process, you go into a scramble mode to try to get picked up unless you want to wait a year and try again. Those scrambled slots are almost all in family medicine, and largely in toxic training programs or very undesirable areas. There's a decent chance your GP finished toward the bottom of their med school class and/or did poorly on their step exams and/or didn't even want to be a GP anyway.

None of this is to say that they're not smart, or good people, or hard working, any of that. But it's important to know the person sitting across from you very likely didn't dream of sitting in that seat the way a surgeon or ICU doc or neurologist very likely did. It changes the dynamic quite a bit. For general medical issues they likely know more than you. If you have a disease or condition requiring specialty treatment, you likely know more about it than they do within the first year or two of specialist visits.

> you go into a scramble mode to try to get picked up unless you want to wait a year and try again. Those scrambled slots are almost all in family medicine,

There's some errors/gross oversimplification in this post. Most scrambled spots are one year prelims, not family medicine. Of the minority categorical scrambled slots more are actually internal medicine, next is FM (but again this is the minority), then neuro, psych, etc.

Also minor point, if you fail to SOAP ("scramble" is kind of outdated), you can find job openings outside of the match system entirely, so waiting a year is not inevitable.

> and largely in toxic training programs or very undesirable areas.

Actually, most of these programs know this and they target FMGs - they tend to fill most of their spots through the regular match. Meanwhile numerous top academic programs SOAP/scramble their prelim spots.

> very likely didn't dream of sitting in that seat the way a surgeon or ICU doc or neurologist very likely did.

IM, Peds, EM, rads, anesthesia, neurology (not competitive at all), PM&R, psych, even gen surg are all relatively non-competitive. You may be surprised about surgery, but all those surgical subspecialty hopefuls that fail to match - many of them end up in gen surg via a "scramble" to a prelim, some may make it on round 2, but many will not and they will go on to an open categorical gen surg program - ie amongst the relatively "competitive" there is the not competitive that doesn't end up where they want to be.

Meanwhile whether your doctor was bottom of the class/poor academic pedigree has more to do with region. The IM and FMs at the top academic major regional centers will often be AOA/top of class/top programs.

IM/FM is just a hell of a lot more variable - it's also very large.

> If you have a disease or condition requiring specialty treatment.....

I dunno if this really has to do with academic pedigree/the process you're calling out as much as scope of practice. Even amazing GPs, unless they have a particular personal interest in something cannot faux subspecialize in everything.

> They spend the entire time asking questions from a screen, most of which I answered last time, while staring at the computer. It feels more like an interrogation.

It's like dealing with a shitty support script.

Yes! Honestly that’s a much better description of the feeling than my own!

I go to a family doctor in his 70s for this very reason. He isn't in a rush. He (or his nurse) actually looks at the old form responses instead of asking me the same old questions. He cares about me beyond the list of symptoms, and asked about the job I started a year ago at the last visit.

I feel like the move to larger clinics (at least in the US) over old school one physician offices has standardized the process and made it more bureaucratic. But there could be a more human approach if someone actually cared to invest in it. I don't see it happening when larger practices and health systems are optimizing for cost and throughput.

Edit: grammar

"I feel like the move to larger clinics (at least in the US) over old school one physician offices has standardized the process and made it more bureaucratic."

The cause and effect might be backwards here. Many physicians retired or consolidated as regulations increased, and ghe cost of complying with the regulations increased. For example, we saw a lot of this when digitization of files became mandatory.

It is ultimately the influence of Federal Healthcare programs that have pushed small doctors out of business. The cost of regulation is ENOURMOUS. And the following effect is that because the federal government is the largest spender in the sector, private insurance companies tend to follow suit, making the whole thing worse.

I don't have a solution for solving medical billing, but it's a huge racket and it's driving up costs.

So in the end we basically get the worst of both worlds. Sigh.

> But there could be a more human approach if someone actually cared to invest in it.

Most people cannot afford a more human approach.

Yes, you could have googled the symptoms, but do you have the background & experience to evaluate the results?

Anyone can google "how to program", but you wouldn't put those results into production, and yet professional SW engineers do that all the time because they have the background and experience to evaluate the results.

Which country if you dont mind me asking? I know of many similar stories about doctors typing stuff into google and prescribing paracetamol from the UK, Spain or Germany - but it's hard to imagine such a situation in central europe.

United States.

It seems much of medicine today is about following the established protocols so you don't get sued. Reading checklists off the screen fits this well.

I honestly can't wait for AI doctors.