Weed a giant who has kept his edge

At 89 years of age, you'd think a man might mellow.

Not Dr. Lawrence Weed.

In introducing Weed as the keynote speaker at the physicians' symposium Sunday, the day before the official start of the Healthcare Information and Management Systems Society's annual convention in New Orleans, veteran informaticist Dr. William Bria quoted Isaac Newton.

“If I have seen further it is only by standing on the shoulders of giants,” Bria said. With Weed, Bria said, “We have all stood on his shoulders.”

Weed—the father of the problem-oriented medical record and the SOAP note (Subjective, Objective, Assessment, Plan) that for decades have directed the orderly way in which physicians think as well as create medical records—also in 1984 developed one of the earliest computerized diagnostic support tools, the problem-knowledge coupler. But in addition to being one of the healthcare profession's chief architects, he also is one of its thorniest and most persistent critics.

A health IT iconoclast, Weed is the co-author of “Medicine in Denial,” which is both a jeremiad and a prescription. He wasted no time with his HIMSS audience of more then 200 physician computer experts before launching his critique. He talked about a hypothetical patient comes into the exam room “and says they have a pain in the belly,” Weed said. “The public thinks that you know all the 70 causes of chest pain. There is not a doctor in this room who would stand up and say, 'I know all that.' ”

“What does that mean?” Weed asked, rhetorically. “It means we're all playing with half a deck. If they have a disease with the 50% you don't know, I don't know what's going to happen to them. We can't do what the public thinks we're doing. ”

Weed recalled Austrian philosophy Karl Popper, who described three worlds. World one is “everything out there, rocks, trees and you and me.” World two “is what you think is out there and what you see and what you think you know.” World three is what is publishable, reviewable, subject to scrutiny that can be checked and confirmed by others.

“Healthcare is stuck in world two,” Weed said. The records in medicine still can't be scrutinized and checked to determine what works and what doesn't.

“Medicine is a $2.3 trillion industry with no accounting system,” Weed said, and “it's killing us financially.”

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