A Techie New Year’s Wish

My dad gave me his fetal stethoscope as a gift at the start of residency. It’s a slender, wooden stick with a cup on either end, one for the doctor’s ear, the other for the pregnant woman’s abdomen. During his career, he had used it hundreds of thousands of times to listen for fetal heartbeats. I can tell from the well-worn nicks and scratches, and the smoothness of the stem, that the tool has served a meaningful purpose in my dad’s hands.

When I trained, I had electronic fetal monitors. Instead of holding a wooden instrument to my patient’s abdomen, I used a small ultrasound probe, and all of us in the room listened together to the galloping fetal heart tones. Moms and dads invariably got emotional when they heard their babies for the first time. I enjoyed those beautiful moments of bonding. Simple technologies triumph in our clunky health care system.

The American health care system is notoriously archaic when it comes to technology. Even in the era of the Internet and cloud computing, fax machines are still the mainstay for the transmission of medical records and insurance paperwork. I shudder to recall the hours lost during residency to locating the rare functioning fax machine so I can get patient records -- assuming it was normal business hours and an actual human being on the other end of the phone graciously agreed to find, copy and feed in the requested documents. Without the information readily available, patients often had to have lab work and imaging tests repeated.

Even now, newly-renovated hospitals run on an inadequate number of computers that chug along on Windows 98 and lack the infrastructure to accommodate physician order entry. In the United States, people move 11+ times and hold 15+ jobs during the course of their lives, meaning they frequently switch their employer-based health insurance and hence their doctors. For the sickest of the sick, they could be brought by ambulance to different emergency rooms within the same city during the same month, and receive the same million dollar work-up because the two institutions have no direct way of sharing information.

Modern sociocultural and economic trends demand that doctors efficiently manage and piece together fragmented data. While media companies are fighting to redefine the boundary between privacy and networking, hospitals balk at harnessing the potential of interconnectedness, citing security concerns. Surely, corporations and the military industrial complex have created the technology to guard their secrets across the globe. Why are we so nervous about wiring our health care system for the 21st century?

Health care professionals are responsible for some of the ambivalence. When I speak to physician-administrators about this question, they lament the younger generation’s desire for costly gadgets. We want to stare at computer monitors, rather than interact with human beings. Instead of honing observation skills, we just process people through machines for diagnoses. They condemn the Internet as a reckless source of misinformation. They equate clinical algorithms with inferior “cookbook medicine.” For many decades, they had few tools and hand-written notes, and healed people. Why complicate something that works?

True, we sometimes overestimate what technology can offer in promoting quality of care and patient safety. Doctors may order too many tests hoping more data will point to an answer, when perhaps we should first pay closer attention to the patient’s story. Residency programs have tried giving PDAs to trainees and found no significant patient or provider benefits. Despite the growing popularity of robotic surgery, there is minimal evidence that patients do better or that the hi-tech approach saves money.

However, I also hear in these naysayers the fear of becoming obsolete, the unspeakable dread that it is a matter of time before doctors, like factory workers and chess champions, are replaced by supercomputers. I don’t believe that day will ever come. The human aspects of doctoring can never be replaced with intelligent machines. Breaking bad news should always been done in person, not relayed over Skype. Few would want to text about whether or not they would choose CPR if their heart stopped. The art of healing requires face-to-face conversation and skilled clinical touch. The process of making tough choices demands empathy, experience, respect for spirituality, and the creativity to adapt to unpredictable circumstances. Even Siri can’t embody those essential characteristics.

My dad’s fetal stethoscope is an exquisite, timeless symbol of the art and history of medicine. It will always work. Yet, looking ahead into the New Year, I wish for technology that improves the connection between doctors and patients, and helps people manage the joys and uncertainties of their physical conditions. I imagine a ‘Facebook’ for doctors and interactive apps for patients. I dream about an invisible network that eliminates the bureaucracy of our health care system and makes its services accessible to the most vulnerable populations. And maybe there will even be a cloud that finally ends the era of fax machines.