How technology affects the physician-patient relationship

A couple of recent readings tie nicely together. In the latest issue of The Hastings Center Report, Naalla Schreiber tells of a hospital stay during which her complaints were not easily attributable to any obvious medical problem. Her physicians used the code words “functional syndrome” to describe her problems, and she described her treatment as less than pleasant. Until of course, tests finally provided a medical diagnosis, confirming what she had suspected all along. In the meantime, she became what many physicians would regard as a difficult patient. It’s not like Schreiber is new to the medical profession either: she is a practicing psychiatrist. Her analysis of the situation puts some of the blame on technology:

“As medicine becomes more technology-oriented, less time and emphasis are placed on learning and practicing the art of the doctor-patient relationship. Patients, are viewed as the sum of their diseases, rather than as unique individuals with physical, emotional, and spiritual needs that impact their health.” 

Well said, and here’s to improved communications!

The independent practitioner is also being hit from all angles, one of which is the drive toward more technology. The New York Times relates the story of a physician whose business is threatened by lower reimbursement and the need to see more patients in order to continue as a viable business. His patients like the extra time and personal attention he enjoys providing them, but he cannot do both. The physician’s son explains that his father’s business model “is going to be extinct very soon,” and notes that the amount of time and money needed to employ an EHR system would be another blow to his ability to keep the business going. Fewer and fewer physicians are self-employed, as more join large groups and specialize.

Is there a balance then? Must the “personal touch” and technology be mutually exclusive? Is there a way medicine can become more technology oriented while maintaining respect for the human component? Does it matter? Each patient has a narrative, and so does the medical profession. How will that narrative read in another ten years?


– Rod Piechowski

© 2011 The Art of Medicine and Technology

Leave a Comment

Watson vs. Humans

IBM’s Watson computer, which recently made an impressive showing on Jeopardy!, will next be tasked with helping clinicians in the healthcare environment. In a deal with Nuance Communications, Inc., Watson’s Deep Question Answering, Natural Language Processing, and Machine Learning capabilities will be combined with Nuance’s speech recognition and Clinical Language Understanding to address the increasingly complex demands of healthcare diagnostics. The IBM press release has more details (and lots of capitalized words) on the deal.

One of the hotter topics surrounding Watson’s dominant performance over the course of the three day demo was its (his?) spectacular failure in Final Jeopardy!. The category: US Cities; the answer: “Its largest airport was named for a World War II hero; its second largest, for a World War II battle.” Watson answered “What is Toronto?” IBM’s explanation suggests that Watson relies on statistical analysis for its reasoning and that it downgrades the category description in importance because in this game, they can be vague or downright tricky. But you and I would immediately recognize “US Cities” as a constrained set in which the answer must reside. Watson was confused further, IBM explained, because there are several “Torontos” in the US.

Oh-Oh! If you look at the map they provide showing the various cities in the US named Toronto, it is clear poor Watson must depend on what others tell him is true. As of this writing, the map (click on “What is Toronto?”) labels “Toronto, MO” as being in Illinois, and “Toronto, IL” as being in Missouri. I thought Watson was impressive, and I think IBM has made great strides. As Watson demonstrated, machines can make mistakes. As the map at IBM’s site demonstrates, humans make mistakes too. We just have to remember that at least for now, the only knowledge computers can learn, is what we offer them…

[Update February 21, 2011: Alas, IBM appears to have removed the map above from its website. Cached versions don’t link to the map anymore either…]

© 2011 Rod Piechowski, Inc. Consulting

Leave a Comment

Information trumps technology

A friend of mine has worked at the same company for over 25 years. It’s rare nowadays indeed, but my friend is special to the organization. She is not the company’s CEO nor its CIO. She is not a partner and she is not in a highly visible position outside of the company. The company has been around for over 50 years. It is multinational and you’d recognize the name if I told you. The company has been through many changes. Its fortunes have risen and fallen in concert with the tides of the marketplace. This company has had its share of layoffs, but my friend has survived the cuts, for better or for worse. The company she works for has always tried to stay on top of the technology required to manage the incredible amounts of data that it collects, and as part of that effort, it has seen many iterations of application development, implementation and system retirement. Yet, through it all, my friend remains at this organization because her expertise lies not with the technology, but with the organization’s business model and its data. » Continue reading “Information trumps technology”

Leave a Comment

Technology as Gateway to Knowledge

(This entry is also available as pdf download: see end of article for link.)

“Meaningful Use” is upon us. Hospitals around the country are scrambling to assess its implications which, aside from the obvious financial investment that must be made, will affect healthcare providers in other ways for many years to come. Since change is inevitable, this is the perfect time to look beyond the short-term aspirations of meaningful use, and identify what healthcare should look like into the future, maybe even as far as 20 years. The government however, is not likely to create that vision, so the task will be left to those providers who are bold enough to shape new models for healthcare delivery. » Continue reading “Technology as Gateway to Knowledge”

Leave a Comment