Pretty much same argument could be said against checklists ('paper controlling humans is a violation of basic human dignity'), but it is a thing that consistently improves outcomes in medicine.
In general, it is restricting autonomy in order to improve consistency and quality.
> Pretty much same argument could be said against checklists
No, the same argument most certainly cannot be made against useful patient safety tools like simple checklists. Not only are they useful, they are simple and integrate seamlessly with pretty much any workflow without obstructing them.
Meanwhile poorly designed software can go so far as to actively impede the work being done which I have no doubt is the case of the software described above and its micromanagement of nurse's work.
Bad paper forms also makes things bad. It's not only the software's problem but the system's problem that human make. Valid criticism for current software system is that it's hard to improve without programmers who work for it.
Bad paper forms can at least be ignored or partially filled. Software can enforce validation and actively impede work until the constraints are satisfied.
> it's hard to improve without programmers who work for it
Any programmer who wants to improve things should probably volunteer at a local hospital or shadow a physician in order to grok what the actual work is like. Ergonomics means adapting the work to the human, not the human to the work. In my experience, healthcare software is all about the latter and it really shouldn't be. I guarantee programmers would hate it if they were forced to use tools that were as hostile to them as healthcare software is to staff.
I said rigid computer software controlling humans is a violation of human dignity. Nobody ever said that about checklists. I'll never understand the resistance to them, they're extremely useful tools.
Your article touches on an interesting point:
> I also think this culture is generational
> my experience with younger doctors in training is that they readily, even eagerly, adopt systems that help them avoid mistakes.
> They never knew a day when medicine was not so horrifically complex and ever changing that physicians could not use some external help to aid their inadequate brains.
Certainly matches my experience at least. I will use literally any resource I can to prevent mistakes of any sort. Computers are a huge force multiplier as everyone here knows. My computer knowledge is extremely useful in this field. Just being able to touch type swiftly already gives me enough of an edge.
I refuse to accept poorly designed software getting in the way of work. I don't know how this Epic software works but where I work using an EMR system has been a terrible experience every single time. They fail at every usability principle that's ever been posted and discussed here on HN. Last month I dealt with one shitty system that had 2 second latency while typing, nobody was able to get any work done and all the problems went away after they all fell back to writing notes in Word or even Notepad. I actually debugged and fixed the problem in a couple hours but at that point nobody really gave a shit anymore because they had already moved on with their lives.
Only if you're extremely dishonest in comparisions.
Checklists at its core is just a list of common/required actions grouped in a list to don't forget during routine tasks. There is nothing limiting here, it is just a tool to aid repetitive/rare/complex tasks.
Exactly. The checklist has no endogenous enforcement capacity. The software defined world is wholly different.
“In a fully developed bureaucracy there is nobody left with whom one could argue, to whom one could present grievances, on whom the pressures of power could be exerted. Bureaucracy is the form of government in which everybody is deprived of political freedom, of the power to act; for the rule by Nobody is not no-rule, and where all are equally powerless we have a tyranny without a tyrant.”
In general, it is restricting autonomy in order to improve consistency and quality.