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.

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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. ...

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

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