Medical Technology-confusing even in 1955

Medicine has changed so dramatically since I graduated medical school in the 1980's, that it is hardly recognizable.

Certainly there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path.  For example, when advanced imaging techniques such as "CAT" scans and MRI's became available, we were able to see the inside of large numbers of patients but we didn't know what was really normal.  One thing we found in quite a few people was a small growth on their adrenal gland.  Many of these patients were subject to operations and it ultimately turned out that the growths were harmless.

This is one of the problems with undergoing medical tests.  You have to deal with the results.  Sometimes the results are incorrect, leading to further testing and treatments.  Sometimes the results are correct, different than normal, but still harmless.  An example of this would be the "bulging discs" seen on so many MRI's of the spines of patients with back pain.  It seems logical to assume cause and effect in a patient with back pain and a spine abnormality, yet it turns out that bulging discs are a common finding and usually not associated with pain.

We have certainly improved our treatment in many areas of medicine, but it has come at a price, both in cost and in quality of care.  Too many people can't be seen quickly.  Our attempt to provide care for everyone gas created problems.  We have lower level people doing higher level functions, and they simply can't do them as well.  This ranges from blood drawing to EKG's.  A controversial area is the autonomy given to caregivers that have less formal training than physicians, such as midwives, nurse anesthetists, and nurse practitioners.  The overload of patients has led us to treat by email or video, an idea which is hard to accept when one learned that the basis of quality treatment is a good history and physical exam, neither of which can be done electronically. 

Physicians had it good for a long time, and really didn't take care of the field.  Now there is conflict between physicians and the AMA, and a new voice has arisen at Sermo
Unfortunately Sermo does not have a section for non-physicians, although I think it would be a good idea.

This post was inspired by an item in the Journal of the American Medical Asociation (JAMA) from December 24, 1955 by G.W. Pickering M.D..  It reads as follows:

Machine Age Overtakes Medicine-
As year succeeds year, some new physical or chemical technic and some new and elaborate machine are applied to the study of disease; great claims are always made for the precision of the answers yielded by these technics and machines.  One of the greatest struggles that a practicing doctor has is to keep up-to-date with advances of this kind.  No sooner has he mastered one than another is upon him.  Moreover, the machines or technics are often so complex that he cannot understand them.  He has to take what they tell him on trust...There is a growing tendency for doctors to rely on the information given by such technics and machines in preference to the information which they gain themselves from the history and physical signs.  I am extremely doubtful if this is in the interests of good doctoring, and for three reasons.  First, the errors and limitations of these new technics are not at first appreciated...Second, a thorough clinical examination, which will be carried out only by doctors who appreciate its worth, is the best method of establishing that spirit of mutual understanding and good will which is the core of the doctor-patient relationship.  Finally, to rely on data, the nature of which one does not understand, is the first step in losing intellectual honesty.  The doctor is particularly vulnerable to a loss of this kind, since so much of therapeutics is based on suggestion.  And the loss naturally leaves him and his patient poorer.
End.

I think there was a lot of wisdom and foresight in this 1955 article.  Technology has advanced medicine without doubt, but a good history and physical exam remain the basis of good care.  The explosion of medical technology has introduced many useless and expensive technologies as well as pure snake oil, in addition to the useful technology.  Marketing directly to patients has made it more difficult for physicians to practice good medicine and avoid the use of treatments that look wonderful on television but are not in the patient's interest. 

We have a lot of work to do, but I think that physicians still have the best interests of their patients in mind and are the only ones who can fix what has broken, even if we played a role in breaking it.

The New Technology-Rudeness

We live in a world where the ability to communicate is easier than ever.  We have email, cellphones, faxes, texting, twitter, and more.  Along with the ease of communication has come some negative aspects such as spam and scams.  A negative side that is not often addressed is the loss of a personal human touch.  Many of our modes of communication do not involve face to face, or even voice to voice contact.  It wasn't that long ago that the only way to communicate was by mail or by talking to someone.  Of course there was also telegraph and telephone which were introduced in the mid to late 1800's.

The personal touch makes an enormous difference.  Try merging from three lanes to two while sitting there with your blinker on.  Nobody lets you in.  If you manage to make eye contact with another driver and give them a signal that you'd like to get in front of them, you will almost never be denied.  It's very hard to be rude to people that are real, not anonymous, or just a voice or electronic series of letters.

Dial a wrong number and the odds are you will be treated rudely or hung up on.  If someone actually takes the time to speak with you, figure out if you misdialed or have the wrong phone number, it's a day-making experience.

I recently had three experiences that, aside from being rude, were hurtful, and made me more cognizant of the negatives of our new technologies.

While on a recent vacation, I visited a park where my kids were playing with another woman's kids.  It turned out that she was a single mom, and we chatted for about an hour, ultimately agreeing that the next time I visited I would email her to arrange another play-date for our kids.  A few months later I emailed her to let her know that we were coming down and my kids would love to play with hers again.  No reply.  I tried again.  No reply.  I tried one more time (three strikes and you're out) explaining that I was not looking for a date, that I realized she may be involved with someone, but all I wanted was for our kids to play.  No reply. 

Maybe her email had changed, but I didn't get any returned emails.  I suspect that something in her life made her uncomfortable meeting socially with a single man and that rather than explain that to me, she simply ignored me, which was easier for her.  In fact, she can even put my email address on a list so that it won't even appear in her inbox.

I recently re-connected with an old girlfriend.  We shared a few long phone calls and many emails, all within a period of a couple of weeks (while her married boyfriend was out of town).  We even made plans to meet, although we live several hours apart.  Suddenly my emails received no reply.  My phone calls went unanswered.  Did she die?  Is she in a coma in a hospital somewhere?  Or did her boyfriend find out about me and get angry?  The first two are unlikely, the third is more likely.  I would understand it had she taken the time to consider my invested feelings and politely explain that we could not continue our friendship.  Sure, I might have argued for it and this would have made it more difficult for her.  So, the easy way was to ignore my calls and emails, eliminating the need to deal with an unpleasant situation, eliminating the need to admit that she was controlled by her married boyfriend.  I think we all know that the easy way is not often the right way, especially when human feelings are involved.

Once in a while I look through some personal ads.  A few months ago I came across one that sounded so right that I decided to answer it.  Her ad mentioned that she did not want to post her picture on the internet since we live in a small community (although I don't really see what's wrong with admitting that one is looking for a partner.  That's a natural thing to do and online dating is pretty mainstream, but I could understand her reluctance).  She did promise that "your picture gets mine".  Well, I sent her a nice email and enclosed several pictures of myself.  No reply.  I waited a few weeks and sent her an email reminding her that she had promised to send her picture.  No reply.  I'm sure that she decided I was not for her, or perhaps she was inundated with so many responses that she simply could not reply to them all.  Whatever the reason, she had made a promise and she had not kept it.  I had gone out on a limb, introducing myself to a stranger and including my pictures, so that I was no longer a stranger to her.  I consider it rude to not reciprocate when one has promised to.  The irony is that her ad mentioned that she was sensitive and kind, that she hated rude people, etc.  My feelings were hurt.

I'm not suggesting we treat spammers and scammers with courtesy.  Their intentions are bad and I don't include interactions with them as real human interactions.  They are like a bad side effect of an otherwise good medicine.

But we need the human touch and I'm afraid we are learning to do without it.  Without it we become depressed.  We become uncivilized.  We become unkind.  It's like the odd experience of visiting New York City where one is surrounded by people, almost none of whom will look you in the eye or greet you.  It would be nice if we remembered that there are human beings with lives on the other end of our computer/cellphone/fax and the rules of human interaction are still appropriate.  People need people.

Why I blog

I have always enjoyed writing and that's why I decided to start a blog.  I haven't written much since college and I thought this would allow me to sharpen my skills again.  It was very easy to start the blog.  I had expected to have to learn about the complex process of creating a website, but it took me about two minutes using Google's blogspot.  I'm sure there are many other options available, each with their own advantages and disadvantages, but I am not able to comment on that.

I eagerly began writing again, enjoying the feeling when a good sentence was created.  I hope to write essays about things I know about that I think would interest the public.  My ultimate goal is to refine my writing to the point that I can begin submitting pieces to magazines and perhaps write a novel.

I searched for websites about how to make a blog successful.  Some things were obvious:  write regularly, choose topics that are of interest, but others were less expected.  There is a whole language that was new to me.  There are various rating scales for blogs based upon how many visits they get and how many people click through to links on the blog site.  Once again it boils down to money.  Apparently there's gold in them thar hills and people are after it.  A successful blog can generate money.  How much, I don't know.

Every forum I found about blogging was essentially about how to make money with one's blog.  This is not necessarily a bad thing, but it would be like searching how to catch fish only to find websites about how to win fishing tournaments.  I was more interested in taking my kids fishing, if you get the analogy.

Some blog forums allow you to post your blog's website on your forum messages, but only after you've achieved a certain status on the forum.  This usually means that you have posted a certain number of messages on the forum.  The result is numerous mindless posts that are intended simply to increase one's message count, such as "Nice post, bro", or "I totally agree, dude".

One forum had a post with a list of hints at how to make your blog successful.  Since I had been reading a lot about this very subject, I recognized the article as an almost exact duplicate of an article I had read on another site.  A couple of people mentioned this fact but their comments were ignored.  I posted a comment, my first on this website, stating that the article was plagiarism and the person who posted it should be removed from the forum.  As yet I have received no replies.  I did get my first post though.  Only 59 to go before I can put my blog's website on my postings.

Meanwhile I am enjoying writing again.  I have to admit that I periodically search for my blog on google, hoping that one day it will pop up in the results, or that I will receive comments from strangers on my blog's posts.  Even comments from friends would be nice.  I can't say that it wouldn't be nice to make money from my blog either, but that is not what it is all about, at least for me.