By Rose Brazilek

Harvey Cushing, the renowned neurosurgeon, once wrote of surgery:

“I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.”

While technology has not yet advanced to such levels, medicine is increasingly shedding its archaic image and beginning to engage with the technological enhancements that characterise the 21^st century. However, with this increased uptake comes a new set of challenges, many of which have no precedent. Evolving discussion surrounding the impacts of such technology on patient interaction, education and care is a critical adjunct to the adoption of electronic practices that will ultimately change the face of medicine.

Over the last century, technology has enabled a greater depth of knowledge regarding patient health: echocardiography now localises heart lesions when once a stethoscope gave the only clues, and ultrasound is relied on over palpation of the pregnant abdomen. However, it must be ensured these investigations are not viewed as an alternative to basic examination skills and observation. To be correctly interpreted, investigation data must be correlated with patient history and examination information: one study determined that, while history and examination information misled physicians 1% and 2% of times respectively, imaging techniques provided misleading information for 7% of patients.¹ Investigations have played an increasingly prominent role in patient diagnosis and management, and research funds allocation have reflected this shift.² With the excitement of new technology comes increased uptake, and it must be ensured that investigations complement, rather act as alternatives to traditional medical practices.

In busy hospital settings, it is tempting to supplant the act of physically taking vital signs or conducting examinations by simply using the observations from electronic monitoring systems. It may be that with the lack of vigilance and rapport that otherwise accompanies actual patient contact and examination, patient deterioration may go unnoticed, resulting in a greater number of complications. Indeed, even when technology is utilised as a fail-safe measure, as in patient assistance alarms, the percentage of false alarms is as high as 99.4%³, resulting in so-called ‘alarm fatigue’, which may have dire consequences: one study found three patient deaths per 277 reports concerning alarm response. It is the technology that must play adjunct to established medical practice, rather than the converse.

Logistical problems are synonymous with the uptake of new technologies, especially in the often-traditionalistic mindset of medical professionals. One such example is the ever-contentious computerised patient record systems. While either a paper-based or electronic system is serviceable, it is in the uptake period, in which there is destabilisation of recording until adaptation occurs, that there is the greatest risk of data loss.⁴ Some hospitals have even experienced ‘physician rebellion’⁴, disenfranchising hospitals of the experience and making repeat attempts at implementation unlikely. Physicians cite difficulties in changing work practices, lack of integration of technologies across systems and perceived cost of implementation as barriers to uptake.⁵ However, these difficulties are not insurmountable, and are perhaps reminiscent of the medical profession’s stubborn adherence to traditional practices, rather than a reflection on the technology itself. When implementing such new resources, quality-control must be the key priority, ensuring appropriate education in its use and benefits, and monitoring of appropriate usage. To surmount such resistance in traditional medical culture, strategies including ensuring a united leadership team and engagement of physicians in the implementation process have been identified to assist in uptake.⁶

This meteoric rise of technology has also impacted the engagement of patients within the healthcare system. Patients now have infinitely greater access to medical knowledge due to the advent of the internet, and thus a greater degree of health literacy.⁶ While this is of benefit in early recognition of symptoms, it also alters the dynamic between the patient and the healthcare system.  Patients take a more active, informed role in consultations due to the erasure of once-exclusive health information, and doctors must alter their consultation styles to reflect a more educated client.  Patients also become more akin to consumers, researching performance statistics of hospitals and individual physicians. With this increased propensity to seek information from sources other than healthcare professionals comes erroneous decision-making borne from lack of providence of quality information or consumer’s skills to critically evaluate the information. Recognition of this difficulty is crucial, but easily overcome by health promotion groups to provide quality information in accessible formats.

It is possible that, with lateral thinking, the medical profession may not only exist, but consciously thrive, in the technological age. Recently, Medicare has recognised the importance of improved telecommunications technology in providing care to people in remote and rural areas, and has provided doctors with the means to bill for consultations completed over videoconferencing.⁷ Patients are able to undertake personal data collection previously reserved for those in the medical field, such as home blood pressure monitoring. Integration of such practices into medical care permits a greater onus of health on the patient, as they must take responsibility for this aspect of their health and ensure capability with such technology. Increasing patient responsibility predicates increasing patient vigilance in turn, which must be supervised to ensure undue anxiety is not borne out of increased access to monitoring. The treating physician must recognise their role to assist patients in this evolution of patient care by providing instruction in the use of such devices and applications. They must also judge individual patient preference and capability in their treatment, and recognise when such advancements are becoming problematic.

It would seem that technology within medicine is here to stay, and its impact on patient examination, treatment and rapport cannot be overstated. In turn, doctors from all realms of medicine, from public health to general practice, must adopt such technology and adapt their practice to suit a more educated, vigilant public, while maintaining their core examination and history skills, which will always underpin the proficient doctor’s practice. By examining the medical profession’s current response to the uptake of technology, important extrapolations may be made about the future.

References

1. Kirch W, Schafii C. Misdiagnosis at a university hospital in four medical eras: report on 400 cases. Medicine (Baltimore). 1996 Jan;75(1):29-40.
2. National Health and Medical Research Council. NHMRC Grants Funding 2000 – 2014 Summary Tables. Canberra, ACT; 2015 June 16. 9 p. Report No.:1.
3. Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Adv Crit Care. 2013 Oct-Dec;24(4):378-86.
4. Poon EG, Blumenthal D, Tonushree J, Honour MM, Bates DW, Kaushal R. Overcoming Barriers To Adopting And Implementing Computerized Physician Order Entry Systems In U.S. Hospitals. Health Aff (Millwood). 2004 Jul-Aug;23(4):184-90.
5. Doolan DF, Bates DW. Computerized Physician Order Entry Systems In Hospitals: Mandates And Incentives. Health Aff (Millwood). 2002 Jul-Aug;21(4):180-8.
6. Cline RJ, Haynes KM. Consumer health information seeking on the Internet: the state of the art. Health Educ Res. 2001 Dec;16(6):671-92.
7. Department of Human Services. MBS and telehealth [Internet]. Canberra ACT: Australian Government; 2015 [updated 2015 August 12; cited 2015 September 13]. Available from: http://www.humanservices.gov.au/health-professionals/services/mbs-and-telehealth/

Feature image by Doctorqmd at Wikimedia Commons