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Hands-On Doctoring Is Still The Core

By Steven Z. Glickel, MD

It was suggested that I address the issue of how our “practice deals with modernity. Is technology a blessing or a curse.” I have been practicing hand surgery for 35 years and have seen significant change in the mechanisms and methodology of practice. When I started there was relatively little intersection of technology and day to day practice. Informatics was just beginning to be introduced in areas like clinical laboratory medicine but in the office none of us had computers or laptops, All notes were hand written; clinical photography and radiography was all on film. We had hundreds of X-rays and thousands of kodachromes around the office.

As with a lot of things, the anticipation of change was a lot worse than the change itself. My clear recollection is that the initial adoption of the various elements of technology seemed at the time to feel like a curse but that was usually short lived. The actual incorporation of technology into practice has, on balance, been mostly a blessing. A case in point was our adoption of electronic medical records in 2009. The first few months of the conversion was unpleasant. It was particularly challenging for someone like me whose keyboarding skills rivalled that of a 3 year old and who also has a passion for using fountain pens which became rarely necessary.  However, once we were up and running, the benefits became apparent. All of the patients clinical and laboratory data was readily accessible. Chart retrieval became more efficient and predictable. Charts do not get misplaced any longer. Our storage requirement decreased dramatically.

However, all is not rosey. The notion that EMR makes the office flow more efficiently is a myth in my experience. The level of detail in the electronic medical record requires considerable time and effort to complete. I think it adds rather than saves time and more than a little of it is redundant or superfluous.

When our radiology department came to us to inform us that we would no longer use film several years ago, we got all hot and bothered. That did not last long. Digital radiography is clearer, more accessible and much more efficient than film. It is so much easier to scroll through the dozens of images in a CT or MRI study than to paw through sheets and sheets of images on film. The same is true for digital photography which has enhanced efficiency and image storage and provided us the opportunity to spend hours manipulating clinical photos and playing with powerpoint.

The interactions of the internet and social media with health care and medical practice is both a blessing and a curse. The ready accessibility of information to both physicians and patients can be beneficial particularly for practitioners. Being able to do literature searches in a matter of minutes and view videos of surgical procedures is a great asset. Patients often do not have the knowledge base to discriminate between accurate and specious information which can be problematic but they do like the notion of being “informed consumers”. The impact that online evaluations of physicians has had on the way medicine is practice is profound. When I ask patients how they came to see me, the increasingly common response is that they checked my online evaluations or looked at evaluations on the insurance company website. This system can be informative to the patient but can also be “gamed” to the benefit of the less than scrupulous practitioner.

Overall, my feeling is that technology has been a blessing, not a curse in my practice. Having said that, clinical medicine is, and for the foreseeable future will continue to be, based upon knowledge, analytic skills and intuition. While technology is making inroads into that realm, old fashioned, hands-on doctoring is still the core of what we do. While techniques like telemedicine may extend the reach of practice and computerized algorithms may systematize decision making to some extent, most people, myself included, want a smart, compassionate warm-blooded person to make a diagnosis and treat them.

Comment (1)
Kenneth Garrod, MD
September 21, 2018 12:37 am

Technology has had a profound impact on displacing a multitude of professionals. I agree a smart, compassionate warm-blooded person still has a role in our profession. Unfortunately, with computerized algorithms and artificial intelligence it is likely our role as physicians will also completely morph and become a medical technocrat.

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