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Are we are obstructing the doctor with gadgets?

Despite billions of dollars of investment in technology the results in healthcare are disappointing.

Information Technology (IT) surrounds us every day. IT products and services from smart phones and search engines to online banking and stock trading have been transformative. However, IT has made only modest and less than disruptive inroads into healthcare. Nicolas Terry (2013)

This was predicted in a prophetic article by Gregory Hackett (1990) when he concluded that:

The primary reason is that technology alone does not determine corporate performance and profitability. Employee skills and capabilities play a large role, as do the structures of day-to-day operations and the company’s policies and procedures. In addition the organisation must be flexible enough to respond to an increasingly dynamic environment. And products must meet customer requirements. Investment in Technology-The Service Sector Sinkhole? SMR Forum Service

However, there are still those who seem enamoured of machines:

Rapid growth of robotic industry is leading to novel applications in medical field. Evolution of new terminologies like tele-presence, tele-medicine, tele-consultation, tele-diagnosis, telerounding, tele-health centers, tele-doctors, tele-nurses are overwhelming and required to be readdressed.  Iftikhar

That way leads to a nightmarish world in which we push vulnerable people onto an assembly line and healthcare looks like this but also includes the dehumanising impact of machines:

….. hospitalists care for sick inpatients and are charged with rapid throughput by their administrative overlords; nocturnists do this job as well — but at night; intensivists take over when work in a critical care unit is required; transitionalists step in when the patient is ready to be moved on to rehabilitation (physiatrists) or into a skilled nursing facility (SNFists). Almost at the end of the line are the post-acutists in their long-term care facilities and the palliativists — tasked with keeping the patient home and comfortable — while ending the costly cycle of transfers back and forth to the hospital. Finally, as the physician-aid-in-dying movement continues to gain support, there will be suicidalists adept at handling the paperwork, negotiating the legal shoals and mixing the necessary ingredients when the time comes. Jerald Winakur- The Washington Post

Technology now impinges on every interaction- for better and for worse:

There were the many quiet voices who urged circumspection as long ago as 1990:

Diagnosis is a complex process more involved than producing a nosological label for a set of patient descriptors. Efficient and ethical diagnostic evaluation requires a broad knowledge of people and of disease states. The state of the art in computer-based medical diagnosis does not support the optimistic claim that people can now be replaced by more reliable diagnostic programs. Miller

One could not argue against technology as a tool but the art of medicine requires that technology helps the doctor. People are not disordered machines and the promise of better health is not forthcoming as we throw money at machines hoping for greater access, efficiency, and safety. However, there is now mounting evidence that the patient is not responding and it’s time to pause for thought, again.

It’s not that complicated. Healthcare works when the doctor and her patient are on the same page. So to what extent does a gadget or gizmo allow that? Does it help them to:

  1. Work out what’s wrong together?
  2. Make it easier for them to work together?
  3. Make it easier for them to achieve a goal together?

If it becomes a substitute for the doctor it will disappoint. People respond best to human doctors. No ifs or buts. Medical school 101. Doctors also have choices in how they deploy and interact with technology. Turning to face the computer, ordering a test and recommending an app aren’t always the way to the best outcome.

Picture by Guian Bolisay 

Comments

  1. Great article. As a doctor come Clinical UX Specialist, I have to talk about and tackle these issues almost daily.

    The whole idea of technology enhancing the lives of others is missing, but that is partly because modern medicine is not just about healing people. It’s political, it’s target driven (including monetary targets), it’s even for bragging rights at times.

    True patient centred care and user centred design is not universal. Until it is, things won’t get better.

  2. Great article.
    From my perspective, the focus on technological advances and (in the USA) the myriad new payment/billing requirements are distracting physicians and health care systems from the low-hanging fruit research in other areas has produced.
    Since as early as the 1970’s we’ve known that stress is at the root of 65-98% of all illnesses and diseases. We know more today because we understand that stress has an adverse impact on immune, digestive, CNS, and cognitive functions. We know that stress can make a healthy meal unhealthy via the body’s biochemistry. We are also far more adept in reducing stress now than the early, off the cuff, recommendations that were put forth when the connection between stress and health was first recognized.
    Human relationships and caring interactions reduce stress. The machines distract the physician from the caring/healing touch.
    We’re plunging ahead at a rapid pace, doing things because we can without evaluating the should. It’s time to pause and put some thought into where we are going and why.

  3. To the patient who lives 3 hour’s drive from a specialist, telemedicine is a massive time saving and gives them far greater access to better care.

    To the IT-enabled hospital, IT helps reduce mistakes and provides valuable statistics that can drive best practice far quicker than a clinical trial.

    To a time-poor doctor with many patients, apps can provide a far better, longer time education pathway than can be provided by the health care team, to provide answers to questions at any time (eg. diabetes),

    In the bad old days, doctors were on a white pedestal and could not be questioned. We now recognise, that doctors, just like any other trade or profession, have a range of education and ability, from crap to excellent.

    Better educated patients = more questioning of doctors.

    Bring on the day when doctors can speak to patients with patronising them,

    • There are many excellent examples of the good that it is possible to do with technology. On the other hand when technololgy is abused- deployed inappropriately it can and does no good.

  4. User Experience with gadget clutter (and other KISS-class IT) is solvable by extending ROI with Return-on-Adoption, IoT framework that is semantically-interoperable, and noise-cancelling informatics techniques with AI.

  5. M Higgins says:

    Technology for the sake of technology is not a solution. Replacing a human with a machine claims to reduce the cost of delivery by eliminating the human factor. The value proposition of care is in the human to human interaction where signs and symptoms are reviewed and discussed in real time. Tech is only supposed to augment the process, not be the process.

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