Technology, Medicine and Money

We so much to the wave of technological advances that have enhanced our ability to accomplish our mission. But we also need to do some hard thinking and planning about how best to integrate the rate and means of technological change into the practice of medicine, or run the hazard of having our possible future utopia distort into a dystopia.

Technology, Medicine and Money: The great trifecta of our professional lives. We owe so much to the accelerating wave of scientific and technological advances that have enhanced our ability to accomplish our mission.

And yet. And yet.

It seems that so many rapid technological developments can and do get ahead of us, so we often get carried along and do not have the time or wherewithal to reflect, to analyze or just catch our breath. Even the Silicon Valley minds that are driving many of these developments do not presume to know where exactly all of this will lead.

For example, the import of the Internet with its ability to interconnect all physicians and access all medical information ever developed has by itself turned our historic "each physician stands alone" model upside down. It's only the high cost in money, time, re-education, and re-adjustment in doctors’ traditionally reluctant approach to change in general that has damped the full reach of the Internet's influence on medicine so far.

Every practice with which I am familiar has been significantly disrupted -- financially and organizationally -- in the process of converting to an Internet-based model. Be very careful if you are about to make the changeover. These Silicon Valley types that I cited often speak of the “disruptive” effect of their technologies with pride, but they either discount or are ignorant of the fact that disruption is a euphemism for somebody else's pain and financial loss. Maybe they should put some of their energy and innovation to work in the service of swifter and easier transitions.

There is also no promise that all of these technological advances will result in an improvement in patient well-being, less economic waste and/or progress in physician functioning. Without a deep rethink, we will still be on our own -- except that we will be better-connected, in a strange new environment, without a handbook. Sort of a macro version of how I feel every time I un-shrink-wrap some new gizmo with a thick, user-unfriendly instruction book.

Maybe part of this is generational. I once sat in a group being instructed on a new medical computer program. I was plodding through when my eye caught a young physician sitting next to me, racing along. I said, "Excuse me, but how old were you when you got your first computer?” She replied: "I don't remember." It rang through me like the death knell of the old order. I could do the new program, but I was not wired to do it. Now we just have to wait to see what the new "cyborgs," to steal a phrase, make of their opportunity to reshape medicine.

There is no question that medicine is not only in the midst of one of the biggest changes in the history of man, but more is coming … fast. And we need to be nimble; it would help, too, if we didn't feel that we are on our own, that we collectively don't have our backs being watched by our affinity and guild organization leaders. I can assure you that more than a few of them feel just as stressed and off balance as we do in grappling with systemic change on a large scale.

If we are increasingly connected, where do we draw the line? Aren't doctors stressed out enough without becoming virtual air-traffic controllers or 911 operators? It has been useful, to a point, that new technology has made learning the science of medicine more direct, especially for students. But where or when do we gain the wisdom to masterfully use this mountain of data and the machines that generate it?

It seems that the tail of technology is wagging the dog of medicine. Maybe we are in thrall at the wrong end. No, we're not talking about going back to some fantasized time of comfort when we were limited to physical diagnosis and "bedside manner." It's not only too late for that, it never was such a good thing to have little else to offer. (Plus the Dr. Welbys and the Doc Adamses never saw enough patients to make a living at it — tech or no tech.)

The high cost of implementing new technologies in medicine is a significant driver in pushing the reorganization of how doctors position themselves to serve patients, too. I've mentioned that last year more physicians took salaried jobs, often under a hospital's aegis, than opened their own store. It just plain costs too much to equip a state-of-the-art practice on your own. (That is, aside from record student loan debt, lack of access to managed-care patients, inability to get further business loans, and an utter lack of training in how to set up and run a business, for starters.) And small private practices are an increasingly archaic and inefficient way to fill our mission to patients.

We really need to do some hard thinking and planning about how best to integrate the rate and means of technological change into the practice of medicine. If we do not collectively and individually do so, we run the hazard of having our possible future utopia distort into a dystopia. Quo vadis?