25th Annual Scientific Assembly

25th Anniversary Story

Submitted by: Tom Scaletta, MD MAAEM FAAEM

I was asked how the practice of medicine has changed since I began my career.

The most positive disruption that has occurred since I began my EM residency three decades ago is the advent of clinical informatics.

Advancements in EMRs and IT applications keep us in control of the ever increasing complexity of EM so that our practice remains safe, efficient, and rewarding.

OK, I’m biased. I’m a nerd.

I studied mathematics and computer science as an undergrad and took AI classes in 1983, before it was a thing. My favorite post-grad job was Fortran coding for an actuarial firm.

After my EM residency, I joined the faculty at SF General and became known as “the data guy.” I moved mainframe data into a FileMaker Pro database to help the real researchers with their projects. A few years ago, I became sub-specialized in clinical informatics and I currently oversee a team of programmers for a technology company.

At the beginning of my career, the medical record of a medically complex patient would be in the form of a large stack of thick binders that would be wheeled into the ED on a cart.  I would task an intern to flip through hundreds of pages and find a specific test result. This now takes seconds. For each patient, I hand wrote prescriptions and a paragraph of discharge instructions. Now, I barely touch my pen.

Someday, a cousin of Alexa, Cortona or Siri will listen in on our patient encounters, filter out the chit-chat, and create a structured, detailed HPI. Completed test results will trigger evidence-based treatment suggestions. Upon discharge, diagnosis codes and charges will be assigned, e-prescriptions sent to the preferred pharmacy, and video instructions forwarded to the patient.

As machines more accurately learn to read images, the traditional roles of radiologists and pathologists will become obsolete. Conversely, EPs are irreplaceable. We will always be the interface between the objectivity of medicine science and the subjectivity of “you can’t make this stuff up.”