Saturday, September 26, 2009

More technology, better medicine? Maybe not

I took creative writing courses throughout medical school and during my 3-year residency in family medicine. Although these often provided a much-needed outlet from the stress and intensity of long days and nights spent in one hospital or another, paradoxically I usually ended up writing about patients I'd met, or how I felt about doctoring in general. I wrote the following reflections during a creative non-fiction class that I took at Elizabethtown College (PA) in the spring of 2003.


Lancaster General Hospital doesn’t stand out from the air. Looking down from a twin-engine Cessna taking off from the Smoketown Airport on the outskirts of Pennsylvania’s Amish Country, the most noticeable features are the farms, the country roads connecting them, and a hundred or more churches. One might still imagine a midwife going from house to house delivering babies with nothing more than clean towels and a basin of water, or even (in the not-so-distant past) the old-time family doctor with his black bag of tools and potions.

My mother gave me one of those shiny black bags after my medical school graduation. The most I can say is that I’ve used it as a carry-on for weekend trips. Not once have I taken it to see a patient. But I did hold one of these bags years ago, from a retired mentor who had inscribed his initials on the gold-plated clasp. The leather was worn through in several places, and it smelled quite old and promised magic inside. The contents – a stethoscope, reflex hammer, tuning fork, and blood pressure cuff – were disappointingly standard, and the thermometer was electronic rather than mercury. The bag seemed to imply that there was no room in medicine for nostalgia.

Modern-day medicine is often hidden behind layers of technology and increasingly sophisticated ways of diagnosing patients’ ills without actually having to touch them. The other day I read a newspaper story about a robot “virtual” doctor who makes rounds with a physician assistant, wheeling into and out of rooms with a video screen showing the real doctor, hundreds of miles or more away. This, the author implied, is progress. The story also quoted a physician’s prediction that robots would “transform the delivery of medical care.” He went on to compare the efficiency of the traditional “laying on of hands” to a gas-guzzling 1950s Chevy.

We doctors are trained from day one to create and maintain the illusion that all of medicine is an organized enterprise, from the numbers of specialists assigned a case to the technology purchased and utilized, to every order we write and action we take.

It’s not. Usually, it’s chaos and disharmony and waste. ...


... which is why we need health reform now!

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