rathe.medinfo.ufl.eduRichard Rathe, MD - College of Medicine, University of Florida

Richard Rathe, MD Associate Professor of Family Medicine (ret.) and Medical Informatician 1 Mar closed Thoughts on the Approaching COVID19 Pandemic By Richard Rathe •• Posted in Medicine , Patient Care source:nytimes.com (click to enlarge) I’ve annotated this NY Times graphic, rounding the estimates for COVID19 (aka the 2019 novel coronavirus) to 2% mortality and 2 people infected for every one who has the disease. What this suggests is the infection rate will be similar to a bad cold season, but unlike the common cold, a significant number of people will die of the disease. This is not good news, but it is also not catastrophic. By comparison the 1918 Spanish” Flu had a similar infection rate but killed 1 in 10 ! The 1918 Flu infected approximately one third of ALL the people on earth … and that was before air travel! Based on these numbers alone, up to 110 million people in the US could be infected. 80% of these cases should be mild, 20% will need some form of special care in hospitals or at home, and 2% (2.2 million) could die . One area where the 1918 Flu differs from COVID19 is the latter does not seem to kill children , which is a small bright spot. However, children may be a source of infection for vulnerable adults ! Note that the currently reported mortality rate is over 3% but here in the US we have done almost NO testing , so the total number of infected individuals is unknown, but likely to be much higher. This means the reported mortality rate is probably inflated due to lack of good data. I’ll stick with 2% as a conservative figure for now. It is also important to remember one of the lessons of the 1918 epidemic, things may look better when warmer weather returns but this should not be reassuring. In the spring of 1918 it looked like the disease was weakening, but it returned with a vengeance in the fall and winter! Social Isolation and Hand Washing For the general public, not living with or caring for a sick person, wearing masks really doesn’t help. Social isolation (eg, staying home) and effective hand washing remain the best things you can do to prevent getting most viral respiratory diseases (the common cold, influenza, and the new coronavirus). Just being in the same room with a sick person is not that risky, but touching surfaces and objects in that room and then touching your face is a good way to catch one of these viruses. Note that hand washing studies suggest we generally neglect our fingertips (including the nails) and wrists. Wash Your Finger Tips! The best information available comes from CDC and WHO (which I consider the best source since it is not caught up in US political shenanigans). For up-to-date worldwide information download the most recent WHO Situation Report .Tweet Tagged as: coronavirus , COVID19 , hand washing , pandemic , public health , social isolation 22 Jun closed An Alternative Symptom Score to Replace the Overused 10 Point Pain Scale By Richard Rathe •• Posted in HPI , Medicine I was taught in medical school that pain scores were only useful for tracking progression/remission for individual patients. In my opinion it was a fundamental mistake to apply this tool as an objective vital sign” across all patients. It simply doesn’t work that way. Scores remove context! During my training we used an implicit 3 point scale: mild, moderate, severe. In later years I pondered why I still preferred this over the newer 10pt version. I decided it was because a 3pt scale is easy to tie to function : mild=annoying, mod=disruptive, severe=disabling. I think the average patient views their condition in similar terms, rather than my pain a 6 or a 7 out of 10.” If you take the 3pt functional symptom scale and couple it with a 3pt frequency scale : intermittent, frequent, constant—then you have a 3×3 grid that might be more meaningful than a one dimensional 10pt scale. It may be appropriate to record more than one score , for example: the patient has constant mild dizziness (3/1) with occasional disabling episodes (1/3).Tweet Tagged as: clinical documentation , pain , symptoms 17 Aug closed ShortNote – Clinical Shorthand 1.0 By Richard Rathe •• Posted in EMR , HPI , Patient Care I have worked with home-grown and commercial Electronic Medical Records  for over thirty years. The use ofdot commands ” (a period followed by a trigger phrase) is about as old as personal computing. (I first encountered dot commands in the WordStar word processing program during the 1980s!) These commands generally fall into three categories: a) links to retrieve data (name, age, lab values, etc.), b) links to specialized services or applications  and c) macros that expand into canned” text . I’ve always found the later somewhat cumbersome and an impediment to fluent typing. While working on a new set of macros for my Rational HPI Project , it struck me that all those periods were getting in my way . (I can touch type but special characters generally slow me down.) This is particularly true when using many short fragments. I decided to experiment with a standardized clinical shorthand  based on these criteria: Include common abbreviations when they exist. Expand common but potentially dangerous abbreviations into plain text (qd, qod, etc. are often banned in written notes). Make the triggers (aka shorts”) as mnemonic as possible. Prevent transformation of non-shorthand text. (A paragraph of plain text should generally pass through unchanged.) Limit punctuation and the need to use modifier keys (i.e., shift, alt, control, etc.). This is especially important for handheld devices such as tablets and smartphones. My first attempt resulted in approximately 130 Shorts (listed below). Note that I’ve repurposed the article ‘a’ and the pronouns ‘I’ and ‘us’ , since they have very little value in problem-focused notes. The goal is to generate functional documentation with the fewest keystrokes —not flowing paragraphs. Typing all lower-case is assumed but not required. Capitalization is only enforced for canonical abbreviations (HPI, ROS, RUQ, etc.) and certain keywords that are frequently missed (NO, NOT, LEFT, RIGHT). Punctuation is optional and should be kept to a minimum. How much punctuation to add automatically is an unsettled issue. At this time I include colons when a list is expected and commas for certain qualifying phrases. This is subject to change. I have an expanding number of disease and symptom shorts that are not listed here. Ultimately these may need to be specialty specific. Finally, certain phrases are included to support the needs of billing and compliance. Clinical Shorthand v1.0 ‘99′ indicates any number and ‘zz’ any phrase. Time unit ‘i’ indicates m(i)nute. Other time units are what you’d expect. Prolog 99 f 99yo female 99 m 99yo male hx history of cc presents with ccn presents with new cco presents with onging ccc presents with chronic Time 0d a few days 0 = a few 99d 99 days 99xd 99 times a day e99d , episodes lasting 99 days s99d , started 99 days ago s=sec i=min d=day w=week m=mon y=year Time (latin derived) qd daily bid twice daily tid three times daily qid four times daily qod every other day ac before meals pc after meals hs at bedtime Location l LEFT r RIGHT ls LEFT-sided rs RIGHT-sided bi bilateral ce central df diffuse an anterior po posterior me medial la lateral luq LUQ ruq RUQ llq LLQ rlq RLQ eg epigastic pu periumbilical sp suprapubic rad , radiates to ran , no radiation Onset (os) osg , gradual onset osi , insidious onset oss , sudden onset osu , unknown onset Progression (pg) pgu , unchanged pgr , resolved pgv , comes and goes v = variable pgb , gradually getting better pgbr , rapidly getting better pgw , gradually getting worse pgwr , rapidly getting worse Severity (sv) svi mild svm moderate svs severe sv9 9 out of 10 sva , an annoyance functional for ‘mild’ svh , a hindrance functional for ‘moderate’ svd , disabling functional for ‘severe’ Symptoms (sx) sx symptom sxs plural sxa...