As part of my job, I have the privilege of participating in the delivery of many babies. I was at one such blessed event earlier this week. There were several medical personnel and the father standing around the bed of the expectant mother. Due to the wonders of epidural anesthesia, she was quite comfortable, despite the fact that she was in the final stages of labor.
Suddenly I became aware of what all of us were doing — myself, my residents, the nurse, even the father: we were watching a machine. The mother was hooked up to a machine that monitored both the baby’s heart rate and her own contractions. The rest of us stood and stared at the machine. When the machine showed she was having a contraction, we would all turn towards her and encourage her to push, cheerleaders for her and the little life that she was bringing into the world. But we kept one eye on the machine, and as soon as it indicated the contraction was over, we turned away from the mother and towards the machine again, waiting expectantly for it to tell us when the next contraction was coming.
With a sense of deja vu I realized that I had observed a similar phenomenon in the ICU: doctors, therapists, nurses, even family and visitors who had no idea what the little multi-colored squiggly lines on the monitor meant, nonetheless staring expectantly at the monitor on the wall instead of at the patient in the bed. And in my training of resident physicians, I have watched videotaped patient encounters showing them sitting in the office with the patient, staring deeply into the computer screen instead of at the patient who has come to see them. Similarly, in their inpatient work, the residents spend a few minutes on the hospital floor seeing their patients, and the remaining hours of the day (and night) staring into a computer screen, tending to the computerized chart — the “iPatient,” as Abraham Verghese called it here.
The practice of medicine has historically been founded on the physician-patient relationship; on that foundation has been erected an edifice of techniques and technologies, tools for medical practitioners to use in serving their patients. However, it seems that in our time the tools are beginning to attack the foundation of medicine rather than just being used by it. For a variety of reasons, the tools and technologies increasingly become the center of the physician’s attention. Instead of medical practitioners defining how the tools are used, the tools begin to define what medicine is. We are becoming what Neil Postman called a Technoloply: our tools change and determine our practice’s purpose and meaning, our very way of knowing and thinking and relating to our patients.
Edmund Pellegrino once wrote, “Men have always sensed that the more they forged and the more machines they built, the more they were forced to know, to love, and to serve these devices.” (From Humanism and the Physician.)
Next week: Some thoughts on what we can do about the ascendancy of the machine in medicine.