THE DIGITAL DOCTOR

    "While technology, in theory, is the inevitable solution to the inefficiencies of a bloated healthcare system, put into use it can         be distracting, time-consuming, illogical and, at times, dangerous." 

Phew, where did he pick up on the dangerous part?  Could it be when you discover that the only entity, the only single integrated story of your medical history, your procedures and prescriptions, your allergies and pending treatments, your valid contact information, your multiple insurance providers, your last ditch contacts and preferred emergency contacts is in your own head, that stuffed repository of decades of medical history overlaid with yesterday's game scores and this evening's menu plans, mixed with whatever emotional state the latest medical news puts you in?  It's enough to make even a skilled nurse practitioner agitated.

But, says Wachter, that is exactly the state of the current transition - well-intentioned, guided by dozens of very bright people, but flawed and fragile and sometimes downright dangerous.

For example, Wachter talks about the shift from medicine as a human institution to medicine as an industry, a gradual shift that changed so many identifiers.  And the current shift into digital medicine is having an equally immediate and wide-spread effect.  Upon arriving at a new hospital position overseeing residents, Wachter was dismayed to find them huddled in a vault-like room, all focused on a single wide-screen display, instead of passing through the ward, looking at and questioning patients.  Further, he tells a story about the intrusion of the digital world on the patient-doctor connection - A friend tells the story of how he noticed that when his favorite doctor acquired a notebook computer in which he could record patient history, prescriptions, diagnoses, etc., that the device became an inpediment.  Each time his doctor raised his eyes to the patient, asking one structured question after another, the next move found him "head down, "  tap tap tapping a very structured response into the patient record - not a lot of loosely scripted human interaction.  What the patient was missing, lengthy eye contact, was in fact an indicator of the failure of the new IT system to improve patient care.  Feeding the machine, forming the questions and tapping in the questions and responses had become more of the process. 

Wachter claims about the IT systems:  "Instead, they transform the work, the people who do it, and their relationships with each other and with patients... Sure, we should have thought of this sooner.  But it's not too late to get it right."

Does Wachter offer solutions to this unfortunate systems takeover?  Not exactly - and certainly not a 12-step plan - but he does offer glimmers of hope:

    "Almost paradoxically, given the staggering growth in our scientific tools and understanding, we may be entering an era in which we rediscover a physician's traditional role as healer and counselor.  In the days before technology - not just digital health records, but x-rays, blood tests, and modern pharmaceuticals - all the physician could do was be there for his patients (recall Fildes's painting The Doctor.)  Over the last century, our diagnostic and therapeutic tools have grown enormously, but our means for dealing with them have lagged far behind, leaving doctors overwhelmed and sapped of time, joy, and empathy.  If our technology succeeds in helping us manage this information, physicians and other health professionals may find themselves able to return to the funamental work of medicine:  diagnosing, treating, comforting, teaching, and discovering.  It is an inspiring thought, and one that does not feel overly Pollyanaish."