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The Luxury of Certainty

My mornings as a resident involve a deluge of information. I walk into the workroom, neither fully awake nor fully caffeinated. I log in to my computer, and a list of patients stares at me. There are new patients to learn about, old notes to read, vitals to skim over, and results to review. It’s incredible how much is in front of me. Our computers give us access to so many data points, enough to know sometimes too much about a patient before meeting them. They also give us a sense of security. If we forget one of these bits of information, we can look it up. And we can also look up what to do with that information. In just a few clicks, we can remind ourselves of what the data means and what to do about it. It sounds too easy. In reality, though, the sheer amount of information can present a challenge. For the patient with numerous medical problems and visits and medications and procedures, it takes a significant amount of energy and time to understand even just what’s salient.

I recently worked for a few weeks as part of a nephrology consult service in a hospital in Bolivia, where EMRs were nonexistent. There was never a moment where I felt that there was too much information available. The problem was quite the opposite. I was sometimes lucky to simply find a baseline creatinine hidden among stacks of papers that comprised the patient’s medical record. Labs also were not checked every day, and I don’t think I ever saw them checked multiple times. On top of that, access to quick reference material was minimal except through the use of smart phones. The apps available, though, were limited, and many of the providers did not know enough English to engage with the ones we commonly use.

Being limited in access to medical knowledge was without a doubt challenging. Being limited in access to patient data produced mixed emotions. On one hand, it was liberating to not feel obligated to learn everything ever about a patient. A vigilant history and an attentive physical exam also became more important. I learned to be comfortable making decisions with the information that I did have. Ultimately, though, this hardly ever felt adequate.

Medicine is full of instances where the answers are not as clear as we’d like. Because of this, it’s important to be certain about the information that can be easily defined. It’s an essential part of patient care. This was often difficult to do in Bolivia, and I imagine it’s also difficult other parts of the world. Being able to easily access patient data and medical knowledge helps reassure me during my many times of uncertainty. It’s a luxury that I didn’t previously appreciate.

Strengthening health care systems in resource-limited settings requires a multi-faceted approach, and being able to easily access medical resources and patient information is a crucial part of this. It’s especially important as medical knowledge continues to expand. Contemplating ways to implement these changes in a culturally appropriate, economically feasible way is imperative to achieving equitable health care for patients in all corners of the globe. I imagine that it would be a vast change for many places. It would create disruptions in workflow and changes in the medical culture. It would require financial resources, an increased work force, and consumer education. It wouldn’t be easy, but it’s an important – and I would argue crucial – component of facilitating equitable health care.



Hudspeth, James, and Michelle Morse. “Health Information and Global Health Inequity: Point-of-Care Knowledge Systems as a Foundation for Progress.” Journal of General Internal Medicine 32, no. 5 (2016): 572-75. doi:10.1007/s11606-016-3909-6.

This entry was posted in BMC.

One comment on “The Luxury of Certainty

  1. You know how near and dear this is to my heart! Nice work capturing the difference between the lived experience in a US vs low resource setting, Andrea, and a beautiful closing paragraph that puts the need better than we did.

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