After years of disillusionment with regard to the bureaucratization of medicine and dissatisfaction with my increasing inability to care for patients appropriately (issues I wrote about frequently on this site), I retreated, retiring from the practice of medicine in 2014. Having lived a healthy life-style, I hoped to avoid contact with the system, an intention made more possible by the recent trend towards elimination of preventive care practices. Nevertheless, within months I found myself catapulted inextricably into the morass of modern day medicine, experiencing, full bore, the horrors of the system from the other side—from the “patient” perspective.
My first observation: in a system that has sought to improve safety through technological means, errors are prominent. Over the course of two hospitalizations, at least seven medical errors were intercepted and avoided, only because of medical knowledge that enabled me to appropriately question tests and procedures. While most of those errors would have been relatively inconsequential, primarily increasing fiscal costs, two of the errors were potentially dangerous. Moreover these errors occurred despite the use of EMR, instituted to eliminate such errors, since “to err is human.”
But just as alarming was the transmogrification of nursing. As I sat alone in my room and pondered the new role of nurses, I began to wonder what part of their “job description” a robot could not perform? Nursing aids appeared at the door with their self-contained wheeled “companion” to assess vital signs three times a day: they slapped a blood pressure cuff on my arm, put a pulse oximeter on my finger and a digital temperature probe in my mouth; and in 15-20 seconds were wheeling their companion out the door with a cursory look back, questioning, “Need anything?”
Nurses were no different: unless I requested additional pain medication I saw them twice a day for distribution of medications and their “nursing assessment.” They, too, appeared at my door with their “computer on wheels,” scanned the barcode on my wrist band, verified my name and birthdate, distributed the medications, performed their nursing assessment (not determined by the patient condition but by fulfillment of “meaningless use“ criteria) and wheeled their companion away, again with a perfunctory, “Need anything?”
Despite careful gloving and gelling in and out, there was little contact—physical or visual—outside the required interactions. No nurse ever appeared at my door just to check on me—to “care.” There was negligible conversation: no one ever took the time to find out for whom they were “caring.” There was no traditional “nursing care:” no bathing, no massaging, no changing of bed linens. There was a cute plastic triangle snapped into my wristband upon admission containing the words “fall risk”—a category into which all surgical patients are automatically placed–but no one instructed me to call before getting out of bed, nor did anyone assist me in ambulation during my stay.
Moreover, these changes are not relegated to nursing. In twelve encounters with physicians over the last 9 months, only once has a diagnostic hand been laid on me. Physicians and/or providers have listened to my chief complaint, ordered tests, referred me to a specialist, or scheduled me for procedure. They have demonstrated that they are little more than triage experts, a mechanized role easily replaced by robotic algorithmic protocols as well. Nor are these observations site specific: their embryonic development was observed in small hospitals in the rural mid-west as they scrambled to comply with increasing outside regulatory demands.
Sadly, there was little in a nine-month course of medical treatment that could not have been done by a robot. Medical personnel have become so task oriented that there is no longer time for care (a fact recently recognized by the AMA). Nursing has become so mechanized that robots may soon surreptitiously replace them—and no one will notice. Many physician roles will not be far behind. As another author put it, medicine has been “McDonaldized.” If so, it is only a matter of time before medicine follows suit with robotic nurses and interactive computer programs replacing their human counterparts.
While technological advances have wrought tremendous advantages in medical diagnostics and therapeutics, they have effected significant immaterial costs as well. Techology has transgressed its boundaries, threatening the human aspect that is the essence of medicine. Is that a price we are willing to pay? For unless we take seriously the course on which medicine is currently travelling and work to reverse the trajectory–restoring the caring human element to the profession–we will be left struggling to provide “evidence” that sanitizing gel will work on mechanical hands.