By RICHARD GUNDERMAN, MD
Medical historian Stanley Reiser wasn’t kidding when he entitled his best-known book, “Medicine and the Reign of Technology.” To a large degree, technology has taken over medicine. I am not talking primarily about our increased reliance on such technologies as advanced imaging equipment or assistive procedural devices. In such cases, the technology remains largely a tool, and the wielder remains basically in charge. I am talking about a far more pervasive and insidious form of technology whose very name tells a good part of the tale – health information technology.
Many physicians and other health professionals find health information systems clunky, perverse, and intrusive, but their problems go far deeper. Underneath unwieldiness lies the temptation that we begin relying on such indicators to such an extent that we stop attending to our internal resources. Consider the case of the patient said in his admission note to be “status post BKA” – below the knee amputation – but who turns out on rounds to have ten toes. What happened? DKA – diabetic ketoacidosis was mis-transcribed into the medical record as BKA, and the error simply propagated like a virus.
At stake is what we mean by knowledge. Is what we know defined by our own experience – what we have seen, heard, felt, and perhaps even intuited in the presence of the patient? Or do we instead rely on what is represented on a computer screen? Which is a more likely occasion for us to exclaim, “That can’t be right!” – when what the computer screen indicates does not comport with what we have observed of the patient, or when what we have observed in the presence of the patient does not jibe with what the computer is telling us?