The digitisation of
medicine is having a negative impact by eclipsing the human side of medicine,
writes Professor Stephen Leeder.
"There are
times when the diagnosis announces itself as the patient walks in, because the
body is, among other things, a text,” says Professor Abraham Verghese,
professor for the theory and practice of medicine at Stanford University
Medical School, California.
Writing in
the New York Times (16 May), he adds: “I’m thinking of the icy
hand, coarse dry skin, hoarse voice, puffy face, sluggish demeanour and
hourglass swelling in the neck — signs of a thyroid that’s running out of gas.
This afternoon the person before me in my office isn’t a patient but a young
physician; still, the clinical gaze doesn’t turn off and I diagnose existential
despair.”
The state of the US
healthcare system, which means doctors no longer care for real patients, is the
root cause of this young doctor’s despair, Professor Verghese says.
Similar cases of
burnout are not uncommon in Australia where heavy workloads, long hours and
administrivia are increasingly taking doctors away from the essential task of
meeting and treating people, not printouts.
His essay, ‘How
Tech Can Turn Doctors into Clerical Workers’, goes on to describe how patients
sat in hospital beds are just “place-holders” and the work of doctoring now
occurs with virtual patients who reside inside computers.
“Old-fashioned
‘bedside’ rounds conducted by the attending physician too often take place
nowhere near the bed but have become ‘card flip’ rounds (a holdover from the
days when we jotted down patient details on an index card) conducted in the
bunker, seated, discussing the patient’s fever, the low sodium, the abnormal
liver-function tests, the low ejection fraction, the one of three blood
cultures with coagulase negative staph that is most likely a contaminant, the
CT scan reporting an adrenal ‘incidentaloma’ that now begets an endocrinology
consult and measurements of serum cortisol,” he writes.
“The living,
breathing source of the data and images we juggle, meanwhile, is in the bed and
left wondering: Where is everyone? What are they doing? Hello! It’s
my body, you know!”
This is how the
disillusioned young doctor before him has ended up as the highest-paid clerical
worker in the hospital, says Professor Verghese, adding that for every hour a
doctor in the US spends with a patient, they spend nearly two with the
electronic medical record. I doubt these figures are much different in
Australia.
Of course, we can’t
blame the rise of electronics solely for the rise in doctor burnout. There are
other factors at play, such as the increasing load of older and complex
patients that our health system, with its strict divide between hospital and
general practice, is struggling to adapt to with the necessary means for
integrated care.
But it’s clear the
digitisation of medicine is having a negative impact by eclipsing the human
side of medicine.
In a recent edition
of the ABC’s Life Matters, two anaesthetists who had had cancer
were interviewed about their experiences as patients.
They spoke of the
shock of diagnosis, the high-quality therapy they received and their eventual
return to practice.
Both identified
sensitive care as the most important element in their journey to recovery. They
also noted how the time pressures of modern medicine easily exclude it.
Not having time to
listen and interact closely with patients can lead doctors to emotional
exhaustion, cynicism and resignation.
“True clinical
judgement is more than addressing the avalanche of blood work, imaging and lab
tests; it is about using human skills to understand where the patient is in the
trajectory of a life and the disease, what the nature of the patient’s family
and social circumstances is and how much they want done,” Professor Verghese
points out.
“So let’s not be
shy about what we do and ought to do and must be allowed to do, about what our
patients really need.”
It is more
important than ever for doctors to speak out about the caring element of the
profession. For, if patients come to us for technical help and care and we
skimp on one because we are so pressed for time, they will eventually seek help
from a different health professional.
Just look at the
billions of dollars Australians spend on alternative medicine each year, which
suggests that they are already seeking treatment, and care, from others while
we busily attend to machines.
Related reading:
- New healthcare robot 'easier
to talk to' than a doctor, say patients
- We GPs must embrace technology
to remain at the centre of patient care
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