Guest Op-Ed: To Whom It May Concern
The Future of Clinical Decision Support is a new series from MDCalc exploring how AI, evidence, and physician judgment are reshaping medicine. These essays are intended to spark discussion about where technology is taking clinical decision support – and where physicians feel it should go.
Written at 1:51am in the hospital, while on call after a day in clinic — with Eminem's “Lose Yourself” playing in the background.
Time to see the patient in clinic. Green light. Focus. What's up with this one?
THIS IS MEDICINE AND YOU ARE THE DOCTOR. Before you talk to the patient, you need a crystal-clear idea of the clinical condition you're trying to identify, along with every clinical variable you need to help the patient — and probably the room full of family members — make a good decision.
Check. We got that from years of training, thousands of prior patients, tens of thousands of conversations about medicine with people we trust and respect and try to emulate, and more days and nights and weekends than we can count spent reading studies and knowing the evidence and the guidelines. You got all that. Not the best analogy, but like Eminem said — you're about to lose yourself in that patient, in that moment. You get one shot to make that first impression and show the patient you can be trusted.
You're sitting there with clinical expertise. The real challenge is finding where the data is residing — or hiding — across multiple disconnected, fragmented electronic health record systems. The EHRs within the EHRs.
You need the needle in the haystack. Actually, the needle in the haystacks.
You need to know how to search every nook and cranny of Epic and Care Everywhere and whatever other connections do or don't exist — every tab, every click, every search down a maze that sometimes ends in a nugget of information and sometimes ends in nothing. And then there's the media tab. And the faxes. (What are we doing in 2026 still depending on faxes? And pagers?)
And on top of all that: you need to know what's missing, and why it's missing. Did it never happen? Did it happen, but the report never made it over? Do you have the report, but it's scanned so blurry you can't read it? Do you have three pages of a fax and the one page you actually need is the one that's missing?
All of that is happening in the middle of a busy clinic, while the ER is calling and the inpatient floor is secure-chatting to ask what to do about something that might be a life-threatening emergency — or might be a request for Tylenol, which is when you remember you have a headache too. (Yes, this is the reality of busy medical professionals.)
We love our job, most of the time. We love our patients, most of the time. So we refocus, and eventually one of two things happens: we find everything we need — EUREKA, GOLD MINE! talk to the patient, make a plan, move on to the next one, sweet — or we give up, and decide we don't have what we need because the records aren't there. And then we start the doctor-patient relationship with an apology: for our team, sometimes for the entire healthcare system. And that's usually met with some version of disappointment — "they said they'd send it all."
So you start the relationship in a hole, and you spend the visit working back out of it.
That is the standard state of medicine and healthcare today.
Sincerely,
YOUR DOCTOR, WHO HATES YELLING IN CAPS