2004: A medical odyssey
Move over, designer molecules, genes, and stem cells. Digital hospitals, cyberspace docs, and virtual patients are drawing the big kudos as the high-tech innovations that will transform the medicine of tomorrow. The electronic health records, computerized physician orders, and paperless prescriptions are an early and visible step in the sprouting of an entirely new nervous system for healthcare delivery in this country. And what draws the almost-too-good-to-be true enthusiasm is that the transformation will improve medicine and save lives and, eventually, money. This cybermedicine revolution also forces an examination of the intangible aspects of doctoring, the doctor-patient relationship that is not as readily converted into zeros and ones.
Will the doctor-patient bond, the timeless keystone of the profession of medicine that underpins trust and accountability, be eroded in the march of cyberinnovation? Will smart communication technologies create a communication gulf between doctor and patient--a new kind of digital divide? Or might the neural networks linking all manner of interactions between providers, payers, and patients, against a background of changing medical science, cry out for a caring physician to bring authority, judgment, humanity, and hope to the individual patient? If doctors are liberated to be high touch in a high-tech environment, taking full advantage of technology to connect with their patients, they could well spend more time as healers.
Patient power. Patients will ultimately benefit in this new day. In the emerging biosphere, they will have tools to better access the complex maze of medicine. Regularly updated electronic records floating securely in the ether will now be only a click away. Personalized smart cards that interact with designated computers are being designed with embedded chips powerful enough to hold these records as well as personalized health and disease prevention prompts, access and insurance plan information, lists of providers ranked for quality, and even a virtual medical library for bedtime reading. Most patients want to be doctors of sorts for their own medical conditions, and these technologies will inevitably bring them more choice and control.
Sci-fi aficionados might envision these patient-smart-card hybrids evolving into something like HAL, the famous computer with threatening attitude portrayed in Stanley Kubrick's 2001: A Space Odyssey. But that's not likely, since doctors in their own parallel universe are heavy into the IT transformation. The ability to readily access records relieves frustration, and getting the latest in medical research on their hand-held computers will keep them a few steps ahead of their patients. Practice guidelines, drug formularies, and safeguards against human error built into these devices will make practicing medicine a lot smarter and more enjoyable. Wireless technology with voice recognition promises to reduce the drudgery of medical record scribing.
Image transfer technology is a huge boon to doctors and hospitals. Digitizing the millions of radiologic images like CT scans and MRI s allows for their immediate transmission to electronic charts and physicians' offices or homes for consultation. It has also enabled the new practice of "night hawking," which relieves radiologists of night duty by transmitting scans to daylight time zones like India or Australia--where they are read at half the U.S. cost. Now there's day hawking and, on the horizon, offshoring doctor visits with telemedicine. Just think: Your sore throat could be treated from Bombay.
But whoa, we're getting ahead of ourselves here. Before any of this becomes widespread, there are complex issues of quality, safety, accountability, and privacy to deal with. Doctors will have to figure out if they are going to be doctors or just see all this as a chance to do less in an environment in which they already feel overworked and underpaid. Will doctors lead this digital revolution, as advocates and protectors of patients, or use it to hunker down and turn off their phones at night?
At the end of the day, a physician's value will depend on whether he or she can still connect to patients in this cyberspace odyssey. The alternative is not pretty. The 21st century might see doctors recede as a commodity into the crowded health delivery ether. Who knows, the sounds of HAL might even make doctors obsolete. "HAL? Come in, HAL. Do I have permission to treat the patient now?"
This story appears in the August 2, 2004 print edition of U.S. News & World Report.
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