Technology in Medicine

This is a thoughtful piece in the New York Times discussing the evolution of technology in medicine.  It is less about breakthroughs in imaging or surgical techniques than it is about the role of technology at the bedside and the continued value of physical examination and of human rapport.

It is particularly evocative to me because of my somewhat unique place within the history of contemporary medicine.  As a doctor in practice now for twenty years, I trained at a time when many of my teachers were incredibly skilled in the physical examination.  Dr. Shaver, the cardiology professor, was famous for being as accurate as and echocardiogram.  For that matter, the echocardiogram was relatively new.  The safety of fetal ultrasound was still not known.  I assisted in as many open gall bladder removals as laparoscopic one because laparoscopy was cutting-edge at the time, no pun  intended.  At the same time, medical students were beta-testers of a program to help doctors make difficult diagnoses based on symptoms and findings such as physical exam abnormalities or blood test or X Ray results.  In other words, I entered medicine at a time of tremendous change in the development and use of technologies and also the very ways in which medicine is practiced.

Like the younger doctor in this article, my "ectopic brain" of pocket-sized books and cards has been happily replaced with an iPhone and dozens of incredibly useful medical applications. Like the older doctor, I have learned the real value of time spent with patients in gathering useful information, performing a skilled examination, establishing real and lasting trust, and coming to agree on plans and treatments.  Like both doctors, I have used electronic medical systems for years, but since I can't touch type and maintain eye contact with patients like the younger doctor (40-60 wpm, thank you very much), I rely on note taking and voice recognition transcription.

Something not really addressed in this article is the incredible opening of information available to everyone on the internet.  I think it's great that patients are now able to find useful information or share it without having to go to medical libraries to find it.  Internet information requires as much critical thought as any other kind, but an interested patient is an informed patient!