As the focus shifts from technology to human touch in moments such as those, it makes me wonder: Is there an inherent tradeoff between technology and humanity?
There’s a moment of pure silence, after you turn off the ventilator and the monitors and the pumps and the ICU bed, when life leaves the room. As a neurosurgeon I’ve shared that dreaded moment with too many families. In the instant after all the bleeping monitors are shut down, and we all agree further intervention is not appropriate, our humanity becomes more clear. The next sound after that stark silence is always the same: Someone starts crying. Then all the people in the room grow very close. When we no longer have the technology to distract, we have nothing left to hold but each other. As the focus shifts from technology to human touch in moments such as those, it makes me wonder: Is there an inherent tradeoff between technology and humanity?
In his 1932 novel, “Brave New World,” Aldous Huxley parodied the utopian science fiction of his time by painting a bleak—even terrifying—view of technology in the future. Huxley’s social commentary is the stuff of legend. It is prescient, compassionate and finger-wagging, all at the same time. His own fears of a depersonalized and dehumanized future society served as the backdrop for 80 years of subsequent writing and thinking by ethicists and sociologists. Today, medicine is so intertwined with technology that it makes Huxley’s futuristic London seem like an out-of-date Star Trek episode from 1967.
In our own brave new world of 21st century medicine, we are presented with a Huxlean dilemma almost every day. I am not ashamed to admit that technology is my frenemy. I love when the technology enables me to address a problem more elegantly; I hate when it gets between me and the patient. Medical and scientific advancements in just the last few years have propelled us to new heights in terms of the scope of treatment options and outright cures that are available to us. Today we can grow and implant a human ear or nose, even transplant a face. A fully functional heart is next. When I operate now I’m so plugged into a microscope, with digital trackers following my instruments and interpolating their position onto an MRI, I sometimes feel like a living robot. There are now entire fields of university study specifically focused on diagnostic medical technology and information management. From 3-D printers that use living cells to manufacture blood vessels, to “telehealth,” to iPhone apps that compute drug dosages, technology is pushing the boundaries of human imagination.
Right here in Arizona, telehealth has recently taken center stage in the public debate. On April 8th Governor Brewer signed into law a bill providing for telemedicine parity—a huge win for our Medical Society. Under the new law, insurers are mandated to pay for medical care delivered by telemedicine the same way they would if was delivered in person. We lobbied hard to get this done because we believe it will open new doors for our docs, providing specialists with logistical access to rural health clinics, and potentially changing the way we all see patients. (Please see the fabulous article by the University of Arizona’s Dr. Weinstein in this month’s Round-up for more information.)
And yet, even as we push the edges of our own frontier, one cannot help but feel that being a doctor is simultaneously the highest and lowest tech job in the world. We excite protons to image the working of the brain, and we still hold our patients as they cry. We operate on the bowel using a robotic micromanipulator, and when necessary we disimpact it with our fingers. In the silent hours when the technology lies quiet, we are there alone with our patients and their families. No amount of technology will ever replace our humanity, never take the place of what’s commonly and sometimes derisively referred to simply as “bedside manner.” Nor should we want it to.
The best and worst of modern technology is without a doubt the Electronic Medical Record (EMR). I hate the way the EMR separates us from our patients. Patients tell me all the time I referred them to a doctor who sat in the room typing through the whole visit. It seems like hospital nurses now spend more time on the computer than they do at the bedside. Charting has replaced caring in many wards. Yet we know the underlying promise. Someday, when we get much better software, the EMR could aid dramatically in communication; the EMR could readily connect us to medical information and data otherwise impossible to reach. The application of big data technology—like that which has been so successful in areas as diverse as speech recognition and predicting the next flu epidemic—can only happen to medicine through EMR.
Innovation has always been a hallmark of medicine. The rapid development of new medical technologies is part of that tradition, and we can expect it will continue apace. Even with the pressures of so-called health care cost containment, patients will expect the best diagnosis and treatment options available—and we will always be on the lookout for new ways to carry out our work. But just as the EMR process separates us from our patients in very real ways, an over-reliance on technology and innovation means we will confront the specter of dehumanizing the physician/patient relationship. We must never substitute an advanced diagnostic technique for a conversation, a patient history, and sometimes a frank discussion of behaviors and consequences.
Aldous Huxley said it best: “Even science must sometimes be treated as a possible enemy. Yes, even science.” As doctors, we will never separate ourselves from the humanity of that final shared silence.