Enshittification, also known as crapification and platform decay, is a process in which two-sided online products and services decline in quality over time.

As some of you may be aware, I was an Infectious Disease (ID) physician for almost 40 years, retiring 3 years ago. My practice was almost entirely concerned with taking care of patients in several acute care hospitals. So everyone whose care I was involved in was sick. ID is unusual in that most of my consults were the odd and usual, infections and diseases, that others could not manage. I once counted 1300 or so pathogens I needed to know for work. Infections can also involve any organ system. It is said the ID doctor has to be the second-best cardiologist, second-best pulmonologist, etc. There was a lot of variety in the cases I saw. If you want an idea of the scope of ID, check out the Puswhisperer, 1300 blog entries I wrote for Medscape. Available on Amazon.

What follows is how I did things, and I do not know how my routine maps on to any other physician.

So I get a consult. Usually a page to a phone number. Here I was kind of a butthead, but I usually asked if they could summarize the need for the consult in 5 words or less. Why fever? Best therapy for Staph bacteremia. Although they often could not, which I took as a sign they didn’t really understand the patient need for a consult. I did this, as I learned long ago that I did not want the bias others accompanying me into the patient’s room. I wanted, no needed, to collect the information my way. Plus, over the years, the ability of residents to give a good presentation had faded. Yeah, I am one of those old geezers who talks about what it was like back in my day, but back in my day we had to be able to summarize the complete patient history is 6 minutes and were only allowed a 3×5 card for reference.

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