If you are interested in a comprehensive overview of the current state of computer and internet technology in healthcare, I highly recommend The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age by Robert Wachter. Wachter, a physician himself, not only inventories the current state of health informatics, but also reflects on how the practice of medicine has changed as result of technology.
One striking change in Wachter’s recollection is the dissipation of the social hub in the radiologists’ office. Before radiology images were computerized and could be analyzed from any networked terminal, physicians had to physically go to a radiologist for assistance in interpreting the film. While digital images offer convenience and portability, there are also elements lost: The collegial relationships between different medical specialists, and the embedded expertise of the radiologist as a core part of the medical team (Wachter does go into some detail about how radiologists currently practice their specialty).
To me, the shifting role of the radiologist is just one example of how we need to work to balance the benefits technology brings to healthcare with the benefits that can only come from a live human intervention. Some of the critical tasks that still require a human touch include:
Striking. Live human beings have the ability to catch and intervene in machine mistakes. Having a human being review computer-generated instructions can be an important precaution that avoids costly or harmful errors. In The Digital Doctor, Wachter details one situation where a medical staff was too overwhelmed with technology-based inputs to effectively detect a significant medication problem. Ideally, a system is not so over-engineered, so that trained professionals have the opportunity to thoughtfully review anything impacting patient care. In one mail-order pharmacy I toured, for example, live pharmacists compared the contents of every machine-filled pill bottle against a reference photograph, ensuring that an educated eye had okayed the shipment.
Seeing. Yes, computers can take in visual data, but they can’t see the way people can. People are still capable of recognizing data that a computer can’t such as emotions or non-verbal behaviors. A live health care professional adjusts her interpretation of what a patient says if that patient is sobbing versus laughing hysterically versus stone-faced. Likewise, a physician will instantly see physical symptoms such as rashes or sores, drooping muscles, or the like; a machine probably won’t (at least not yet).
Soothing. This one may sound odd coming from someone who believes that avatars have an important role to play in empathetic, appropriate health education. But just because we can imprint a relationship on an avatar doesn’t mean the avatar has the ability to respond to our pain the way a human doctor does. Sure, an avatar can deliver educationally appropriate information in a sensitive way, but it can’t pat your hand or offer a comforting anecdote when you’ve just gotten a scary prognosis. Human beings can do those things.
Wachter describes the experience of one patient (a doctor himself) with a technology-reliant physician:
“I had seen him a few years earlier, and I liked him . . . this time, he asks me a question, and as soon as I begin to answer, his head is down in his laptop. Tap-tap-tap-tap-tap . . .”
“What did you do?” I asked.
“I found another doctor.”
Technology is fantastic when it can help physicians narrow in on the right information to make a diagnosis, select a treatment, or monitor symptoms. But over-reliance on technology may lead to errors if humans aren’t overseeing it with a critical eye. It also may, as in the case of the patient Wachter describes, disrupt the relationships patients have with providers.
Maybe twenty years from now someone will read this post and laugh at the old timey blogger afraid of medical technology. If that happens, it means we did a good job adopting technology in health care cautiously and thoughtfully. Future people, I hope you get to laugh away.