Can Technology Bring More Humanity to the Practice of Medicine?
A few weeks ago, I read a very interesting article about how technology can save medicine’s heart and soul.
While there is no shortage of articles that highlight the struggles and frustrations faced by clinicians as we incorporate more technology into their everyday practice, this one had a refreshing and optimistic outlook. Yes, I do think it is possible to bring more humanity to the practice of medicine.
There’s no question that we still have a long way to go and it’s disheartening to hear so many providers complain that EHR technology has become a barrier to providing patient care, when it should be just the opposite. A well-designed EHR is centered on the user, respects the clinical workflow, and incorporates valuable input from physicians, nurses and other staff – they have keen insights into the care they provide and how technology can enhance their process rather than hinder it.
One of the statements that really stood out was the author’s assertion that “Doctors must undoubtedly still learn the ins and outs of diagnosis and treatment and should reserve the right to overrule computers using their clinical judgment”. Each patient is a unique individual, and information is not going to always fit neatly into a pre-defined check box or decision tree. We need to allow more flexibility for clinicians to exercise discretion without jumping through too many hoops within the system or the need to develop workarounds.
I definitely believe that medicine is both science and art – the art lies in an expertise gained from years of specialized training, hands-on experience and a well-developed instinct. While medicine is becoming much more guideline-based, individual clinical judgment is that intangible yet critical human factor that can never be replaced by any decision-support algorithm or artificial intelligence.
Thinking about all of this took me back to my days of working in the ER of a very busy trauma center. Sometimes we would have only a few minutes to assess a patient and determine their level of acuity (i.e., how sick they are and how quickly they would be seen). We didn’t have any fancy technology to help us make this call – we used all of our senses along with our gut instinct, which was formed after seeing hundreds of other patients with similar problems.
I remember one night in particular we were treating a man in police custody with a blunt traumatic injury to the abdomen. Based on the cookbook-style protocols standardly used to evaluate and treat this type of injury, he met all of the criteria to be considered “stable”. As the physician was preparing his discharge papers, and I was getting him ready to go, it struck me that something just didn’t seem right with him. There were no outwardly obvious red flags that raised suspicion – all of the diagnostic findings were negative; his physical exam and blood work did not indicate any active bleeding; his vital signs were normal. Something was just a little off, and I can’t put my finger on what it was that made the hair stand up on the back of my neck. Something just wasn’t right. I convinced the attending physician to keep him around for another hour just to make sure he was completely fine before he was hauled off for what would surely be a long night in central lockup. Sure enough, over the next hour, he slowly started to decompensate – his skin became pale and clammy, his blood pressure dropped and his abdomen became firm and painful. The trauma physicians came to evaluate him again and determined that he had a ruptured spleen, a life-threatening condition, and he was immediately taken to the OR for emergency surgery.
I will never know what he may have done to wind up at the wrong end of a police nightstick, but I can say with a high level of confidence that had we been in more of a rush to get him off to jail, it is very likely that he would not have survived the night. I have no way of knowing this for sure – it’s just a feeling.
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