When Technology Prevents Great Patient Care

I believe most of us have heard the following words of wisdom from a parent or teacher: “There is a reason why you were born with two ears and one mouth.” As a society, we may have a tendency to speak first and listen second.

That tendency can extend to the medical arena where clinicians may also not listen, or quickly by-pass the standard physical exam and reach for the latest test/technology. 

While all healthcare providers, practices, and hospitals legitimately embrace the latest technologies, the overreliance on them ignores the fact that hands on skills should never be abandoned.

A recent article in Kaiser Health News included numerous examples in which physicians reached for the technology first and failed to adequately examine patients. The article described one patient who presented in an emergency room for the third time in six weeks, showing classic signs of liver cirrhosis.

Only after a “veteran” doctor examined the patient and noticed a rapid inward pulsation under the man’s ear, did he confirm his suspicion that the man’s problems were circulatory and cardiac in nature, and not liver related.

The article speculated that the vast array of technologies has supplanted the doctor’s physical diagnostic skills, the foundation of any assessment.

As stated by pulmonologist Salvatore Mangione, associate director of the internal medicine residency at Jefferson Medical College of Philadelphia, “There has been many cases in which technology, unguided by bedside skills, took physicians down a path where tests begot tests and where, in the end, there was usually a surgeon and often a lawyer involved.”

Pediatric cardiologist W. Reid Thompson of Johns Hopkins School of Medicine noted that studies have shown that doctors do a poor job listening to a patient’s heart and lungs. “People walk around with a stethoscope not just because it looks good or is expected, but because there is information to be learned.”

There is also the convoluted reimbursement logic that third-party payers will eagerly pay for sophisticated tests, while paying poorly for the doctor’s time performing a comprehensive history and physical.

In a February essay, (highlighted in the Kaiser article) Arnold Relman, a former editor of the New England Journal of Medicine, described the extended time he spent hospitalized at Massachusetts General Hospital in Boston. He reported that after his discharge, while reviewing his records, he found “copious reports of data from tests and monitoring devices, but conversations with the doctors treating him where infrequent, brief and hardly reported.”

EHRs, sophisticated tests and technologies, can never replace the personal touch and care of a physician. Touching, feeling, and listening are the inherent foundation for all relationships. Medical technologies should be used to enhance the diagnostic skills, not replace them.