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A Computer In Every Doctor Bag!

December 8, 2013

Let’s talk for a moment about medical education.  I went to a work-related party yesterday and rode in the elevator with a dear friend who is my contemporary, and a more senior and highly regarded faculty member known for her work in medical education.  Both were afraid for the future of medical education in different ways.  My contemporary was concerned that the emphasis on the use of advanced technologies like ultrasound will make residents dependent on these devices and unable to function without them. The more senior doctor was actually concerned that residents weren’t learning technologies adequately, a seemingly opposite opinion.

Then I read a nice post on KevinMD by a medicine intern:  In it Dr. Peteet expresses his concern that superficial and strategic learning outweigh deep learning in medicine, and that the residency process emphasizes individual learning of acute illness in a large hospital setting and that the skills of collaboration and teamwork needed in the current medical climate are ignored.  That same site, KevinMD, also had posts touting the advantages of technology in the areas of both education and clinical practice, both authors managing to emphasize the removal of the doctor from the hands-on care of the patient.  One was a wide-ranging and extremely optimistic evaluation of emerging diagnostic tools in the form of computer algorithms.  The other talked about simulators and simulated patients and how awesome and helpful they are.

Look.  You want to learn to be a doctor?  So go doctor.  On people.  That’s what doctors used to do.  Now you’ve got an office where the patient logs in in the waiting room to their personal data page, prints out an algorithm-generated list of medical priorities.  The patient then sticks their hand in another computer and gets their vitals taken.  Then they sit in another office and a nurse comes in and repeats all the information the computer has and asks you what your symptoms are.  She enters it in her computer, which generates a list of what is wrong with you based on your symptoms from most likely to least likely.  Then the med student comes in and repeats it all and enters it in his computer, which he is adept at because he majored in molecular biology and biochemistry.  The resident then comes in and tries to do the same again but his beeper keeps going off.   Another technician comes in and does an EKG with his little machine.  The med student takes his computer (given to him by the medical school) to his simulated patient in his artificial classroom and plays out scenarios involving how to break bad news to this patient or how to do a rectal examination.  The student then simulates doing a venipuncture on the simulated patient.  The resident sits in the back room updating the computer program that tracks his team’s inpatients and calling radiology because he can’t find the ultrasound machine he must have to do an arterial line on 98-year-old Mrs. Jones.  Meanwhile back at the office the actual real patient has not been seen or touched by an actual doctor since his/her arrival.

We have arrived at this utopia in a variety of ways, starting with the way we pick our med students and going all the way through how we organize our private practices.  Med students come fully equipped with a knowledge of how to get ahead in an academic situation and are adept at superficial and strategic learning.  Those who have a deep and abiding care for real people either don’t get in or don’t get far before that care is beaten out of them by the constant demands of technologies that remove the real people from their care.  Residents are used as grunt labor and to fill seats and write orders and chase down X-rays.  The intern sits in the lounge entering data in a computer while the attending deals with the gunshot wound.

We doctor real people.  Forget the radiology images.  Throw out the simulator.  Send the practice patient home.  Sabotage the robot.  Teach caring people how to be caring doctors.  Of the patient sitting right in front of us.




  1. Randy B permalink

    So you went to a work related party. My question is why? LOL.

    There was a joke that one doctor had (maybe on Youtbe) about his parents (both doctors). His parents were educated in India, he was educated here, and he said he was absolutely amazed at how his Dad could physically examine someone and almost tell their life story. His Dad told him he needed to put hands on someone and after he did it enough, he’d learn. He said that we rely too much on technology and that you really needed the patient to make the diagnosis.

    Which scares me for children of doctors going into medicine. They had learned this way and their kids are going to pick up the same thing. Is it any wonder the rates of misdiagnosis and delayed diagnosis are 20-30%?

  2. Phillip Gale permalink

    This problem is in almost every profession. We had aeronautical engineering students from UCSD come out to the Air Museum to work on the airplanes with us. They did not know which way to turn a screw to tighten or loosen it. The gap between the theoretical and reality is usually greater than we think. In the Pastorate no amount of theology or psychology can substitute for practice in dealing with people whose marriages are falling apart, or whose child has been diagnosed with a wilms tumor. It takes a life time of practice with real people with real problems. Perhaps that is why medical doctors call their work a practice.

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