
Why I quit medicine - gautamsivakumar
http://gautams.posterous.com/why-i-quit-medicine
======
larrys
With a title of "Why I quit medicine" you would think somebody quit medicine
because there is something wrong with medicine or the job of being a doctor.

What we have instead is a very well intentioned individual that is getting out
of medicine because they want to run a startup. And that's fine. Maybe getting
jealous because they see it as a path to riches and have been reading about to
many outliers. Or maybe wanting to change the world.

But the job that he does is known as a "hospitalist" in this country.
(Essentially Internal Medicine but not office practice).

<http://www.hospitalmedicine.org/>

My wife is one, and practices in a very modern hospital system. I've asked her
many times about "the handoff (signout)" from the first time we were dating.
Because it seemed outdated to me that when we were at dinner (and she was on
call) she had to scribble down notes about sometimes 20 patients over the
phone). But apparently the verbal interaction is important as well between two
doctors and can't easily be summarized in writing. And I've overheard plenty
of handoffs and can attest to the interactions between doctors and the nuance
that can't be expressed in writing. (I even said why can't the other doctor
just record something that you can listen to and a million other ideas and she
shot all of them down very easily as not being practical. And she had every
reason to support an idea like that if she thought it would make me money..)

Getting things done is difficult, and yes, they are very closed minded and
it's hard to get change.

But drawing a comparison with "Considering I can talk to my smartphone and
tell it to send a message to my dad or remind me to water the plants when I
get home" doesn't take into account that whatever system is setup and accessed
needs to be rock solid, dependable and can't fail in many degrees above your
typical startup offering.

So this is a great ambitious idea that he has undertaken and I wish him well.
But my guess is that he will have to partner with a health system in order to
get adoption of this idea and work out the kinks and prove the concept.

~~~
gautamsivakumar
Thanks so much for your support.

You're right about how important face-to-face interaction is. That is not
going to be replaced any time soon - nor should it be. But for the purpose of
handover, you still need a written summary of all the patients on a ward that
people can refer to. As I mentioned in the post, it would be useful to see who
wrote what about each patient - so that you know who to talk to for further
information. Having a handover application won't replace the morning handover
meeting or a person-person handover - but it will definitely make that process
less painful, more accountable and much more efficient.

(P.S. if I was jealous of the so called riches of being an entrepreneur - I
would have focussed my energies on my medical career and right now I'd be
driving my A5 from work rather than sleeping on a friend's couch thousands of
miles from home :) I don't think anybody who takes this path should be under
any illusion. Most start-ups fail and it's not an easy path. That said, I do
love a lot of what building a company involves...)

~~~
peterbessman
Yeah... hackers are usually incredibly naive about compensation outside of
their own world. For reference:
[http://www.medscape.com/features/slideshow/compensation/2011...](http://www.medscape.com/features/slideshow/compensation/2011/)

Bottom line: here in the US of A, your average doc (most certainly NOT an
outlier) is making between $150k and $350k. Put that in your VC-backed pipe
and smoke it.

(Debt? Between $150k-$200k for 4 years of med school. Post med school
training, in the form of residency and fellowship, runs anywhere from 3-12
years and pays around the $50k mark. Basically, nobody went broke by becoming
a doctor.)

Which means, of course, that the outliers can do _very_ well. I have a friend
who's Dad is an oral surgeon in the Eastern Shore of MD (what might be
considered the "boonies" by some). He clears about $750k/year for a 35 hour
work week. llimllib's wife above is probably around the $250k mark in the
ER/ICU. If that ain't coin...

Anybody who thinks that somebody _left_ medicine for the money knows very
little about medicine.

~~~
localhost3000
take an evening and go have drinks with some current med students / residents
- here's what you'll hear (not from all, but from many): "Obamacare is killing
my profession!"..."i should've gone to b-school instead"..."i could be working
at GS but now i'm busting my ass for $50k"..."i'm getting screwed! this is
sooooo unfair! how am i going to survive this debt?!"...so, the problem isn't
that they don't make a great living - because they do. the problem is that
they feel they're entitled to make as much as other 'smart people' (aka, their
former undergrad classmates at princeton) in other professional careers like
corporate law or banking - which they don't. they still make way more than 99%
of the population, but those people don't matter as a basis of comparison. if
you counter with, "...but, you're a doctor. you're not in it for the money -
you want to help people, right?" you'll get an _extremely_ exaggerated eye-
roll and the conversation will end...so, in short - it doesn't surprise me at
all that a doc is leaving medicine to chase $ in tech now that it's no longer
cool to tell your cronies you work in finance... (there are many exceptions
and God bless them but, I've personally run into too many self-righteous, woe-
is-me med students to know what to do with...) - why do you think dermatology
is such a competitive field? $$$$$$

~~~
itmag
Sounds like unworthy people who are just clamoring for status (which income is
a proxy for) instead of figuring out who they are as individuals and what
their life purpose is.

------
gamble
Sounds a lot like the medical data startup I joined ten years ago. We were so,
so painfully naive about the realities of medical software. Medical records
are a trivial technical problem, but an almost insurmountable political and
regulatory challenge. I knew our company was doomed when we were talking to
another medical software company and saw the literal wall of binders that
represented a single FDA approval process submission. It is _so_ not a market
that's friendly to startups.

~~~
devs1010
Yes, and hospitals have arcane policies / IT departments, my dad is a doctor
and the hospital he works at still has Internet Explorer 6 installed on all
computers there and they refuse to upgrade it for fear it might break
compatibility with some ancient software program they use they access through
it. He wants me to create some little software program to see if he can get
them to use it when the main system goes down but it has to work in IE6 so its
kind of a nightmare and I've been dragging my feet on it because of this...
its things like this that make dealing with healthcare such a pain in the ass.

Thinking about this more, its actually a bit scary if I do create something
and he is able to get them to use it as I could be opening myself up to a lot
of liability. I figure, as a doctor, he should be aware of all this but not
100% sure how up on this he actually is, maybe I should get him to sign
something having him take full ownership and responsibility of the software

~~~
mhurron
>they refuse to upgrade it for fear it might break compatibility with some
ancient software

It will break, in horrible and unknown ways, and even if it didn't if the
company supporting it got wind that you used a different version of IE, or
heaven forbid Firefox, that's probably enough to deny support. It's probably
not even ancient software, they might have purchased it in the last couple of
years. Medical software has to be the absolute worst made software on the
planet.

~~~
devs1010
I think it may even go beyond that, where they have even stipulated what other
software could be run on the machine. I do know, for example, that they HAVE
to run XP, nothing newer, or it would void their support, etc.. its really
insane how companies can get away with that, I don't even understand how for a
web app (it uses a Java applet, so I guess it goes beyond a regular "web app",
but still..) they can demand this sort of control over the end user's system.

~~~
aptwebapps
It seems like there aught to be some sort of liability for mandating insecure
practices for your customers.

------
mgkimsal
Paper isn't secure, but probably more 'secure' than data on a phone, cause
there's far less risk of the paper getting duplicated silently than data being
pulled from a smartphone (silent sending of address/contacts, etc).

Seriously? A shared Word document? With no audit trail of who wrote what? And
_that_ is an improvement over the state of the art? It sounds like Wordpress
has far more robust data management (and probably security) than what he just
described.

As a doctor who can code, I'm sure the OP will be in a great position to make
real change. He knows the regulatory stuff to get past, what rules can be
bent, who the movers/shakers are to get stuff moved. Likely just bringing some
very basic CMS/ERP functionality to medical records management in a hospital
would be _huge_.

~~~
vannevar
_Paper isn't secure, but probably more 'secure' than data on a phone..._

Good point. I'd also add that it's difficult to automate the process of
scanning millions of hospitals for crumpled pieces of paper, whereas scanning
blocks of millions of IP addresses for vulnerable smartphones is something any
reasonably competent script-kiddie can do.

------
arn
I quit medicine too, but not because of the lack of adequate computer
interface :)

The whole taking notes, jotting down patient information. It seems antiquated,
but it's really a hard problem to "fix" - if it really needs fixing. These are
not medical records he's talking about, but personal notes on each patient and
todos you carry around with you during your shift.

Paper/pen in taking these notes is faster than computer/tablet input. I've
tried it. In several different forms. There's a lot of shorthand doctors
develop that help out. Arrows, diagrams, etc...

Still seems a small part of the bigger picture, which is electronic medical
record keeping.

Regardless, good luck with your venture!

~~~
kami8845
>I quit medicine too, but not because of the lack of adequate computer
interface :)

If you don't mind my asking, why did you quit?

~~~
arn
short answer: had kids, and a financially successful website. (longer answer:
<http://news.ycombinator.com/item?id=236308> )

------
tejaswiy
You're getting it wrong I think. I work in healthcare IT and many EMRs are
getting on the mobile bandwagon and building out mobile clients that let you
do this.

Additionally, hospitals require doctors to put in diagnosis / treatment notes
into EMRs which is usually done by transcribing service that the doctors can
call or by sitting at a computer and typing it out. Although this process is
worse than doing it over a mobile client, healthcare IT is not in the dark
ages as people would have you believe.

~~~
gautamsivakumar
Respectfully, I disagree. I think there are some institutions which do it
better than others - but on the whole, from a techie standpoint, healthcare IT
is in the dark ages.

~~~
wging
You came from Britain, didn't you? The situation there is way worse because of
the NHS's failed project.

------
DanBC
Medical notes need to have some obvious design features common to many other
computer software.

\- locking: only one person able to change the record \- auditing: keeping
records of who read what, when, and where they did it \- signing: any
additions are cryptographically signed and timestamped \- sharing: many
clinicians need to be able to access the data across a wide range of hospital
networks.

The UK NHS spent £11bn on a system which was late or didn't appear.

(<http://www.bbc.co.uk/news/uk-15014288>)

About 10,000 people in England die each year because a clinician makes a
mistake with the meds. While that risk is very low (because there are a huge
number of patients taking a huge number of meds) it'd be nice if something
simple could be done to reduce that number.

~~~
gautamsivakumar
Yep, true. The NHS IT project was a perfect example of how not to do it :)

------
kyro
Good on you, man.

I'm in medical school currently and the emphasis on locking down patient data
is one of the most frustrating things to see. I'm convinced that it's a policy
that everyone knows has little benefit and yet pushes for ethical brownie
points. What's to be gained from freeing up the data far, far exceeds what
could potentially be lost.

Even freeing up anonymized patient data seems to be met with opposition.
Imagine the data analysis that can be done on millions and millions of patient
cases and the clinical/treatment models that can emerge as a result.

Medicine right now is an old, stiff wooden board bending under the weight of
technological innovation. Something's going to snap and I'm looking forward to
see it happen.

I really support what you're doing, and if you want design help, my email is
in my profile. Best of luck!

~~~
jerf
"Even freeing up anonymized patient data seems to be met with opposition."

Unfortunately, statistically, "anonymous patient data" is an oxymoron. Any
useful amount of patient data contain enough information to deanonymize it to
a great extent, and in conjunction with other data often fully deanonymize.

[http://33bits.org/2010/06/21/myths-and-fallacies-of-
personal...](http://33bits.org/2010/06/21/myths-and-fallacies-of-personally-
identifiable-information/)

~~~
Symmetry
Quite true, but that does take effort. Whatever we do we're going to have to
make a tradeoff between saving lives and preserving privacy at some point.

------
devs1010
The topic of regulation that others have mentioned here makes me think of the
airline industry also as, from what I can tell, medical regulations are almost
as strict as those, I worked with a guy who used to do programming for devices
on airliners and he said it was basically insane how much regulation there
was, they were still not approved to use multi-core processors, etc so it was
like programming for computers running technology of 10 years ago. I think
people tend to think that healthcare would / should be much easier to use new
technology for as its not quite the same as the aviation industry. However, it
seems this isn't the case in legal terms and the industry may need a
regulatory reform before innovation can really take place. In the case of an
airliner, it really is life or death, however with healthcare, I think they
can put in place enough backup systems (writing on paper, etc), even make the
system do print-outs at set intervals, so if it goes down, there is a paper
record right there, or something like that, so these issues can be overcome

------
jeybalachandran
Thanks for writing this article and good luck with your venture. I'm not a
doctor but my company works in healthcare and deals with the same physician
related problems. So believe me when I say, I understand your pain.

Passing along patient information is a tricky subject due to HIPAA-compliancy.
Most patient information is transmitted via fax machines and doctors are
alerted of incidents through pagers, often carrying multiple. This technology
is archaic and considering 75% of US physicians own some sort of Apple product
there has to be change. In particular, physicians need better forms of
communication that saves them time.

I'm hoping this changes as it will impact us all. It isn't going to happen
overnight but with more and more physicians pushing for change in this area,
one can only hope it happens sooner. If you're interested in what my company
does, check out our website at <https://www.doximity.com> and our blog
<http://blog.doximity.com/> talks about similar problems.

------
mkelley
I work for a company in Kentucky that is currently working on developing a
system (with cooperation from the Department of Health) that addresses this
exact problem. Basically a multi-user application that records all aspects of
each Provider's "encounter" with a given patient. A Provider could be a
doctor, nurse, lab tech, etc... So at anytime the current provider for a
patient has access to all previous "notes" and any other data recorded about
the patient as well as who recorded that information. Though I must admit,
when I first started on this project I was quite surprised that there really
wasn't much out there for public healthcare providers that didn't already do
this. Besides Kentucky, there are several other states showing interest as
well ... I just thought I'd mention that so nobody thinks, "Oh backwards
Kentucky, their doctors run around the hospital barefoot!" Apparently this is
a widespread problem in the public healthcare system across the United States
as well.

------
sungam
Hi, fellow UK hospital doc so fully understand the frustrations with NHS IT. I
suspect problems stem from the fact that purchasing decisions are generally
made by individuals (management and senior hospital docs) other than those
that use the systems (in the main junior hospital docs). The other issue is
that systems are implemented to reflect the way that diseases and patients
_should_ behave but there are always edge cases that do not fit into these
nice boxes. Striking a balance between free-form data input, which does not
add much compared to conventional paper notes, and forcing patient data into
categories and drop-down boxes is a a real challenge. The other thing that is
often forgotten is the amount of clinician effort required for a system. If it
takes too long or is too complicated accurate data will simply not be entered
in the absence of draconian sanctions from above. Anyway there is clearly
plenty of room for improvement so I wish you the best of luck!

------
mattwrench
This article touches on why it somewhat bothers me to see some of my smartest
friends applying to med school right now. I'm sure being a doctor is a
rewarding profession and the work they do is so incredibly important to their
patients--but it's not particularly unique work. Medicine is the application
of the already known. (Most med students are not going to be the next
DeBakey.) Rather than contributing original work, most doctors seem to be
well-paid (and deservingly so) blue collar workers. If someone turns down a
med school acceptance, that school can instantly pull 100 names of their
waitlist who will be more-or-less just as qualified.

Sivakumar is right in that there aren't many doctors who can also code. While
he may not get to feel the joy of directly improving patients lives, this goal
of his seems far more important to the well-being of everyone.

~~~
devs1010
You can make this argument about most software developers too, while they may
create unique applications, they are mainly using the "already known"
(existing languages, API's, etc)... You can then go on to apply this argument
to nearly any other "white collar" job, accounting is "the application of the
already known", etc..

White collar does not mean that you are in a research field and pushing the
limits of knowledge, from what I understand it has long had an entirely
different meaning. Personally, I feel that white collar / blue collar are very
outdated terms. I often feel that a software developer is somewhat of a modern
blue collar worker as its a creative trade and very different from a "white
collar" job such as a sales or marketing job.

~~~
mattwrench
"Blue collar" was a poor voice of words. You're right that the white/blue
collar divide is not a creative difference.

But I still feel that software development is a creative field whereas most of
medicine is reactive. All fields are based upon past knowledge so the use of
APIs seems irrelevant since they are just tools used to create.

The criterion to differentiate between creative and non-creative fields seems
to be whether multiple "correct" answers exist. Obviously in programming the
solutions to problems vary in terms of algorithms,implementations, etc. On the
other hand, medical diagnosis is either correct or incorrect. Even prescribing
treatments seems to be more of "do X with A factors, do Y in the presence of B
factors" rather than an individualized, creative approach.

~~~
kyouens
There is a certain element of truth to what you are saying. When I was early
in my training I was dissappointed in my choice of medicine as a career
because I also thought it lacked an outlet for creativity. As a now
experienced physician, there are still times when you get to a point in the
care of some patients at which the next step is programmatic and rote (if A
then B).

However, sometimes--probably most of the time--the patient's presentation is
so unclear (e.g. "I just feel weird. . . ."), there are so many variables to
juggle in your head at once (twenty different lab values, the way the liver
feels, the imaging findings, the color of the patient's sclera, the smell of
their breath, their mood) that things become far too complex for any
flowchart. These are the times when you need creativity, "book smarts" and
perhaps above all, "emotional intelligence" to be a good doctor. There are
plenty of doctors lacking one or more of these elements, and they just aren't
very good at the job.

~~~
mattwrench
That makes a lot of sense. The above criterion I mentioned does seem to fall
apart since I do consider problem solving to be inherently creative even
though oftentimes there is only one answer.

Good to hear from an actual physician though. Do you think that your initial
disappointment is a unique response or do most med students go through it? I
ask because everyone I know who is getting accepted to med school has wanted
to be a doctor since high school. I assume that makes med students get tunnel-
vision when deciding their career choices and have an idealized, incorrect
view of the field. (I figure most future doctors just get over this pretty
quickly by finding different, but equally important reasons to be in the
field.)

~~~
kyouens
I can't speak for everyone else, but for myself, "tunnel vision" explains it
pretty well. At some point in high school, I just decided being a doctor was a
totally awesome thing to do. I can't remember the real reasons why I chose
medicine, but I know it was somewhat vague. I knew doctors were smart and I
thought I was pretty smart. I am embarrassed to admit I also may have
fantasized about driving a BMW from my big house with a pool straight to the
OR, busting in with an "S" on my chest to save somebody's life.

In college, I was drawn to the humanities and to computer science more than to
biology, but I stuck with it. I was a willing victim of the rather unhealthy
obsession with "getting in" that most pre-meds develop. Medical school, at
least at first, was a rude awakening. It was not intellectually challenging
(other than by virtue of the sheer volume of material), it was rote, the hours
sucked, the and the culture was unpleasant.

It was not until a couple of years into my residency that I started to really
appreciate more of the nuances, and to enjoy practicing medicine. As it stands
today, I love what I do. I help people in a tangible way, I make a good
living, I am respected and valued by my community, and at as I described
above, my creative and intellectual muscles get a daily workout. However, I
don't do any busting into ORs and, sadly, I don't drive a BMW.

------
mmonihan
A strategy that may have a chance, given the current situation:

1\. Befriend and work with a mentor who happens to be high up in the IT
department in a health system.

2\. Create some kick-ass app

3\. Open-source it(use the open-source version as a way for IT people in other
health systems to use your work)

4\. Have your mentor implement that software in their health system as a pilot
project.

5\. Befriend other IT directors and try to sell to them.

6\. Befriend other medical software providers and try to license to them.

7\. Make hay while the sun shines.

------
kitsune_
I don't know, most hospitals around here use something like SAP IS-H/IS-H MED
for patient and resource management. There are yearly "eHealth summits" and
similar conferences. Their IT guys are organized in user groups and societies
where they share their knowledge. Is it an "enterprisey" environment? You bet
it is, mainly because of the regulations. However, the hospitals definitely do
not live in the stone age.

------
peeln
Isn't this addressed by a product like <https://drchrono.com/> (YC!) or am I
missing somethings?

~~~
dr_
Drchrono is an emr. I could be wrong, but I think the author was thinking of a
more focused solution for a specific problem.

------
alphaoverlord
so what's the plan doc? EHR in the style of practicefusion, drchrono, Epic, GE
Healthcare?

------
jhaile
Putting aside income, I think tech/startup jobs are superior to medicine and
law because the majority of doctors are simply analyzing symptoms and
diagnosing using systems and books written by other people; the majority of
lawyers are just interpreting laws written by other people. Whereas tech
startups are creating and inventing solutions to problems that can improve the
world. Don't get me wrong - I'm glad there are doctors out there (may not say
the same for lawyers), but I'd rather be a creator/innovator than someone who
is just interpreting things. Too many smart people get stuck in doctor/lawyer
jobs for income/status reasons that could be having a bigger impact on the
world if they were inventing new ideas and helping create a better world.

------
hschmidt
I am a contractor at a client that does exactly that:

<http://patientsafesolutions.com>

Using a iPod Touch and a proprietary jacket, patients can be monitored and
transferred to the next shift of nurses through an intuitive App. Its really
quite amazing.

------
dr_
Things will start to change soon, there are some signs of this already.
Healthcare remains heavily regulated, and because of this even for profit
institutions are sometimes run as government institutions. This is most
apparent in nursing facilities. Medicare is the predominant payor, and there's
no reason for any facility to go beyond what medicare requires. Why invest in
electronic records, etc? if medicare doesn't require it (although that's
changing now). It's just an added expense.

But it's become apparent to policy makers that Medicare is getting more and
more expensive, and some type of change is going to have be initiated. With
private health insurance, it's the same picture. Costs are going up and more
of these costs are being shifted to the insured (patients). Deductibles have
gone up tremendously, and the days of the $5-$10 co-pay are almost gone.

The solution, in both cases although perhaps implemented in different ways, is
going to have require the patient/insured to be responsible for paying for
themselves directly. On the surface, it seems like a bad thing, but in the
longer run it's a good thing. It brings into play what healthcare has been
lacking - market forces. Almost all other industries have market forces in
play, but not so much in healthcare. Go to a great surgeon, or go to an
average one, they get paid the same. Why? It shouldn't be that way.

But once people have to pay more out of their own pocket, they are going to be
far more careful about who they see. The level of service provided is going to
matter. Ease of access is going to matter. Outcomes are going to matter. How
about a refund if certain things don't turn out as promised?

And that's where there is going to be tremendous opportunities for startups.
To provide technology for patients, and for doctors, hospitals, etc to provide
a better level of service. All parties involved will be actively looking for
these tools at some point.

Granted there are some regulatory hurdles, and HIPAA was really a poorly
thought out piece of legislation, but as the startup community grows, there
will be tools made available to navigate these hurdles as well.

------
drucken
Perhaps its a compensation or cultural issue with medicine in the UK.

But, as a doctor, changing careers and creating a startup, especially one on
the other side of the planet, seems an extreme reaction with extreme risk. Why
not go private or even change geographies but remain a doctor while working on
this problem on the side?

I say this because, given how well compensated doctors can be, as well as
clear and progressive career paths and the strong vocational aspect, the
opportunity cost of this change is enormous!

TL;DR. Are there other more significant issues involved?

------
tamersalama
Why quitting? I see that having access to the problem gives access to numerous
use-cases and ideas.

------
pavanky
Is it just me or does anyone else think all the doctors need is a bug tracking
tool ? Preferably something that can be used from a smart phone / tablet via
an app ?

------
tomwalker
in scotland I worked in a hospital and would have to print out blood results
on a daily basis for, on average, 20 patients. Some weeks it could easily be
60 patients.

To do this would take about 6 clicks and due to the slow system about 40
seconds I figured out. There would commonly be a queue in the morning to use
this computer.

I made a simple script on a pen drive that allowed me to print my bloods for
patients I had on a list of 'my patients'

i got a slap on the wrist :(

------
itmag
So you're a doctor AND you know how to code. Very interesting, please do share
your story about how that came to be :)

------
wisty
I see why it's important to have secure patient records. It would be
devastating to have your personal medical information up on pastebin.

But you know what's worse? Dying because the doctor misses a vital piece of
information which can't be found in disorganized paper notes, or a
bureaucratically designed medical information system (which set the hospital
back roughly the cost of a new life-saving machine).

~~~
mgkimsal
But... the dying will only happen once, then never affect you again. Leaked
medical records may impact you for the rest of your life.

~~~
cchurch
Dying impacts you for the rest of your life.

------
jacoblyles
A good example of the immense unanticipated costs of regulations, in this case
patient privacy regulation.

------
goggles99
I Don't know what hospitals you guys have been in, but my primary health care
for the last 12 years has been Sutter in California. The hand-offs have been
electronic (custom software, not word docs) for that entire time. The Doctors
now carry around a tablet as well to update info about a patient. Before the
tablets, every room had a PC for updating info. Maybe Sutter is just a special
case, I was surprised at the article and some of the comments here.

------
lurker14
Is that really _why_ you quit, or an engaging PR backstory?

As an entrepeneur, you'll have to deal with clogged sinks, office rentals,
legal filings, and lots of other hassles similar to carrying around a piece of
paper.

~~~
neilk
Perhaps you should reread the OP. He's not saying that he personally is above
petty hassles, he thinks it's a problem worth solving.

I bet he also believes he can make some money too, but I don't fault him for
omitting that. Surely that goes without saying.

------
rdg
These guys need to buy this revolutionary product called a notebook. And no, I
don't mean a laptop computer, but a "traditional" notebook. And probably a
bunch of pens. A notebook is harder to lose than a scrap of paper and you can
hand it over to the next doctor so he can read your note and add his own.
Sounds interesting, doesn't it?

~~~
wvenable
That doesn't really solve the problem beyond perhaps the most rudimentary way.
You have X number of patients and Y number of doctors with any number of
overlapping doctors interacting with any of those patients. Keeping doctors
notes in a single notebook won't scale beyond a single doctor.

