Smart Medicine by Hanson

[Guest guest]

BOOK REVIEW

How advances will alter the medical landscape

By Dennis Rosen June 6, 2011

The medical advances of the last century have been astonishing, rivaled perhaps

only by how much we take those accomplishments for granted without pausing to

consider how different our lives would be without them.

Antibiotics and vaccinations that now make infectious disease much less of a

threat than before; complex surgeries facilitated by robotics; sophisticated

diagnostic tests: all these and more have greatly improved the quality and

length of innumerable lives since their introductions.

These developments and discoveries have also altered medicine as a profession.

In " Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health

Care,'' Dr. Hanson, chief medical information officer at University of

Pennsylvania School of Medicine, examines how the field has evolved in response

to some of these innovations, and the ways in which it is likely to continue to

change with so much more coming down the pipeline.

Reminding us that, by definition, disruptive technologies up-end existing

paradigms and that years can pass before the results of their introduction are

fully felt, Hanson explores the ways in which their outcomes can be both

positive and negative. Contrasting the ability of today's on-call physician to

access patient lab results and imaging studies from a computer, with the endless

running about of years past, Hanson also describes how patients suffer when

physicians who become dependent on all of this information suddenly find

themselves one day unable to access it.

Looking forward, Hanson describes the " ICU of the future'' in which patients are

connected to multiple sensors that monitor various bodily functions and that

automatically trigger responses to abnormalities, for instance adjustment of

flow rate of medicines being administered by drip.

The benefits of this model include freeing up physicians and nurses to

concentrate on more complex problems instead of routine care, and for those

problems to be addressed immediately without spiraling out of control because a

nurse or doctor is busy with other patients. However, there are also potential

downsides: How will physicians trained with the new devices and monitors be able

to function in their absence, should the power suddenly go out; or if called

upon to work in other settings? And what will the implications be for the

physician-patient relationship?

Acknowledging that " it is entirely feasible that much of the cognitive work now

performed by medical providers will eventually become so objective, precise and

encodable that the doctor himself might become obsolete,'' he continues by

saying he does not believe that this will happen, as " the most important element

of the interaction between the doctor and the patient is fundamentally human.''

Reflecting upon how advances in cardiac catheterization have brought about a

steep decline in the number of bypass surgeries for blocked coronary arteries

and to changes in the physician workforce because of this, he identifies other

areas of medical care which could (and are already beginning to) be taken over

from physicians by other providers, such as nurse anesthetists and nurse

practitioners. If well thought out, expanding this process will not only avoid

compromising patient care, but will in fact improve it as patient wait times

will be decreased and physicians will have more time to spend with those

patients who need them.

The writing is on the wall: Technological advances will continue to transform

the way medicine is practiced, and physicians must be adaptive to them so as to

provide maximal benefit to patients and to society. Hanson has done a

commendable job in describing the processes at work, and for reminding us that

the changes in store for all of us have potential downsides, which must be

considered alongside the good they will bring.

Dennis Rosen, MD is a pediatric pulmonologist and sleep specialist who practices

in Boston.

http://www.boston.com/ae/books/articles/2011/06/06/how_advances_will_alter_the_m\

edical_landscape/