The Death of Paper and Pen

A couple of weeks ago, we went to our local Science Center and view the exhibit “Lost Egypt.” Aside from the real mummies, there were also very interesting artifacts found in there. I was more absorbed with the hieroglyphics on the catacomb walls, as they built model of those walls in the exhibit. I felt like Indiana Jones trying to interpret these ancient writings. There was also a replica of the Rosetta Stone, a stone tablet with carved writings on it in ancient Egyptian and Greek language. The original stone tablet was believed to have been carved in 196 B.C., and was discovered in 1799 by French soldiers who were rebuilding a fort in Egypt in a small town of Rosetta.

These artifacts just proved that men had been writing for a long long time. It is debatable where the earliest writings originated, as some experts say it was from Mesopotamia, but others claim it was from Egypt. Well, if you consider the cave drawings, which are pre-historic paintings on the cave’s walls and ceilings, and the oldest of which was found in Chauvet, in France, then you would surmise that even cavemen scribbled on walls. I wondered if the caveman’s mother scolded her son or daughter when he or she drew on their home wall.

With the invention of paper, believed to be introduced by the Chinese around 100 B.C., and introduction of pens out of feathers or wood sticks, the earliest use of which was believed to be in ancient India, writing had evolved to the current practice as we know it today, using the universal paper and pens. It is interesting that even astronauts used special antigravity-pens (Fisher space pens) and paper in their space missions.

Dead Sea scrolls, written about 200 B.C. to 68 A.D.

We learned to write with pencils or pens and paper even before we entered Kindergarten, and maybe also scrawled with crayons on our bedroom’s walls, much to the dismay of our parents. Since then we composed our first essay in elementary, drafted a book report in highschool, and wrote love letters in college, all using pen and paper. When we finished our studies, we received a fancy paper signed with a fancy pen and with our school’s seal, as a testament that we graduated. And if you are working now, you sign with a pen a piece of paper (I mean bank checks, but it could be your “listahan ng utang” at Aling Nena’s sari-sari store too) to pay your bills. Paper and pens are so omnipresent in our society and are so integral to our daily living that we may not be able to do things without it. Or can we?

Last week I underwent two days of computer training. No, I’m not switching career, it was just a part of the changing practice of medicine. The hospital system where I practice is launching the use of full electronic medical records in all their hospitals. That means no more paper charts and records everywhere in our hospitals. All orders, all doctors’ progress notes, all nurses’ notes, and all patients’ history, physical exam findings, vitals, labs, and ancillary data need to be entered into the computer.

The good thing is that our outpatient clinic where I am a part of, has been using electronic medical records entirely for the past 3 years now, so I am somewhat accustomed to the digital records. And now the hospital is adapting this change too, which is I believe is the way of the future. I know some doctors (I could be one of them) don’t like it at all. It’s like teaching an old dog a new trick (no, I’m not calling my colleagues dogs). But resistance to this change is futile.

What this means is no more hand writing for me. It’s going to be all typing, mouse clicking or computer pad writing for me. Every hospital room is equipped with a computer terminal, and I would be lugging, aside from my stethoscope, a computer tablet wherever and whenever I examine patients. I wonder what would I do to all the pens I have. Don’t worry mine are just cheap ones, and not like the expensive collectible pens that some friends I know, have. Or maybe someday, pens will be antiquated that they all will be collectible artifacts, so I might as well keep mine.

I also believe that it’s not just the practice of medicine that is going electronic or digital. Perhaps in more other professions than I realize. And honestly, when was the last time you sent a hand-written letter? Is this the death of the era of paper and pens?

With the advent of computer and digital age, and with the current social networks that we have, it is quite funny that we came back full circle to the Stone Age. We are again writing on walls (of Facebook, that is) and inscribing on tablets.

Put@n&1#A! What’s the Password?

Few weeks ago, I broke my office tablet, and needed a replacement. (Chalked it all up to business expenses.) Then a few days later, when I brought my new computer to my outreach clinic, I was unable to log-in to that hospital’s operating system, as it did not recognize my new computer. I had to call IT for help to set it up, which in itself was a painful process.

As the IT guy gave me step by step instructions over the phone to set up, he then gave me the password to type in, to gain access into the hospital system. The password was 25 characters long of random letters and numbers. 25 characters long, are you kidding me?! After carefully typing the 25 characters, it then prompted me to type the password again to confirm. That’s when I almost lost it! After regaining my composure, I was able to complete the task. Whoever decided on that very complicated password, made it more difficult to gain access to their system than to launch a nuclear warhead!

In this information and technology age, we are inundiated with multiple different ID’s and passwords to remember, just to get by in our normal every day activities. Never in the history of man, did we have to use so many secret passwords, even if we are not spies nor secret agents. I know, identity theft is a real problem, but remembering (or not remembering?) a gazillion passwords can be quite distressing.

Having a secret password though, is not new, as it dates back in ancient times. I can picture in my mind a sentry during the Medieval times guarding a restricted passway: he will challenge anybody who wants to cross to give a password. Only those who can answer correctly can pass, and those who answer wrongly will be turned away or worse will be struck with a sword.

 When I go to our outpatient clinic, I have a user ID and password just to log-in to my computer. Then there is different one to sign-in into the electronic medical records. A seperate one for the PACS (Picture Archiving Communication System) to view the x-rays. And if I have to read and review sleep studies, that is another system that has a different user ID and password. Of course, there’s another set  to open my office e-mail. (That’s why I don’t even check my office e-mail anymore.) I’m glad no password is required to use the restroom.

When I make my rounds in the hospital, there’s an ID number and password to check the patients’ database and laboratory, a different one for the hospital PACS for x-rays, another one to complete and electronically sign medical records, and a separate one if I want to dictate my notes over the phone. And if I wanted to cool my heels or get a cup of tea at the doctor’s lounge, then that’s another ID and set of numbers I have to punch in at the door’s keypad to get in. Though I don’t mind remembering those numbers, since gaining entry means free snacks at the lounge.

When I get home, and I have to check my personal e-mails, that’s another log-in ID and password. If I want to check my facebook account, or do on-line banking, or check on my credit card payments, or buy something from Amazon, or download music from i-tunes, or check something from e-bay, or book a flight on-line, or check the status of my Board certifications, or talk to my mother in Manila through Skype — those are all different ID’s and passwords. Of course I have to use a password to access my blogsite and write this grumpy article.

I think I use about 20 different ID’s and password regularly everyday, and another 10 or 20 that I use not so frequently. All of these are clogging my brain. Sooner or later I will run out of memory space. And the worse part is, some of these systems ask you to change your password every so often, some seems almost every month! It is a good thing that if I forget my password, some systems will give me prompters or I can simply re-set it, and will not be smitten with a sword.

Needless to say, there are the other important numbers that you have to remember, like you social security number, or home, office and cell phone numbers, your birthday (or you can forget about that!), your kids’ birthdays, your spouse’ birthday, and your anniversary (or you will be rudely reminded!). With all these things that we are forced to remember, I’m lucky I can even remember my name. My real name that is, and not a user name, which I tend to forget most of the time.

What’s the password? Just smite me!

Technology, We Have a Problem

For a few years now our outpatient clinic had completely adapted electronic medical records. No more paper charts, no more big bulky x-ray films, and no more illegible written prescriptions handed to the patients.

Aside from the stethoscope that hangs around my neck, I lug with me a small computer tablet when I go in to see patients in every examining room. Their records from my office, from other doctors’ office, from the hospital, their laboratory works, and their imaging studies (chest x-ray, CT scans, PET scans images) are accessed at the tip of my stylus pen. The prescriptions are directly sent electronically from my tablet to the pharmacy’s fax.

Last month, one outlying hospital outside of the city I worked in, have invited me for a demonstration, as they are about to launch their project in telemedicine. What telemedicine is, is seeing patients from distance away through video-conferencing.

The patient sits in an examining room in front of a large TV monitor and a camera, in a hospital or a clinic miles away, while I sit in my clinic here in town in front of my computer screen. I control the camera which can zoom with such high-resolution to see clearly even the pupils(eye) of the patient. A nurse at the patient’s room can place the special stethoscope on the patient and I can hear the heart and lung sounds in such high-definition through my headphone set. There are even special scopes that I can look into the patient’s ears, nose and mouth (without smelling their breath!) all through my computer monitor.

 

The telemedicine project’s goal is to bring the services of physicians of different specialties in areas that don’t have them, without having the patient or the doctor leave their locale. The future implications are limitless. Maybe someday I will be in my home pad in Manila or better yet in one of the beautiful beaches in the Philippines (as long as there is satellite signal), while I see patients somewhere half a world away. I know robotic surgery (surgical robots controlled by humans) is still in its infancy. But who knows, someday surgery will be done while the surgeon is not even in the operating room!

Technology is good…… that is, if they are working properly.

Last week, while I was seeing patients, my computer screen keeps on freezing and crashing. I had to reboot it several times, delaying me for many minutes, that it made my patience run thin. Finally I called our clinic manager to give me another computer and have mine fix by IT, before it literally crashes to the floor (deliberately!) and before I give it the real boot (kick it with the heel of my shoes!).

In the future, what if a doctor is performing a delicate procedure or a life-saving intervention through telemedicine technology, and all of a sudden the connection is lost or the computer crashes? Scary thought huh?

"Houston, we have a problem."

This reminds me of Apollo 13 and the famous words: “Houston (or insert name of place here), we have a problem.” With all the advancement of technology, sadly to say, Murphy’s law still applies — If anything can go wrong, it will.