Diagnosing digital difficulties in medicine

    Physician Robert Wachter is the author of

    Physician Robert Wachter is the author of "The Digital Doctor: Hope

    If industries got report cards for how well they’ve incorporated new technology in the work they do, medicine might get an F. In a world connected by the internet, hospitals and doctors offices can seem out of touch.

    But things are changing rapidly, even if belatedly – says physician Robert Wachter. He has written a new book called “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.”

    Wachter said computers have been part of healthcare for a long time, but the field has not made an effort to fully computerize until more recently. “It’s really complicated, and because the people who have to buy these systems often don’t benefit.”

    A $30 billion cash infusion from the federal government helped move things along. “We have gone from 10  to 70 percent digital medical records, so really, medicine has gone from paper to digital just in the past few years.”

    Wachter is a professor in the department of medicine at the University of California, San Francisco, and explained that many of his fellow doctors had reservations about computers coming into their exam rooms. “There were people who were concerned that it would change doctor patient relationships in ways that were not positive.” And some of those fears have come true, with both doctors and patients complaining about the fact that physicians spend so much time looking at their screens during office visits.

    Wachter said the field has also not been very thoughtful in making sweeping changes, for example, medical records don’t ‘talk to each other’ from hospital to hospital. “But it’s hard to be thoughtful,” he added. “The experience of other fields is that you can try really hard to envision what your work will be like, but it’s impossible to do until you are there.”

    Ideas often sound great in theory, but don’t work in practice. Take for example alerts about possible medication interactions. Wachter said that sounded like a solid plan to cut down on bad patient outcomes, but is not really working out in reality. “Physicians get 30,000 to 40,000 such alerts in a month. In our Intensive Care Units, the monitors throw out 2.5 million alerts every month, so, people stop paying attention.”

    Another potential problem with increasing computerization is providers going on autopilot, and relying on technology too much. “We had an error in my hospital, where we administered a 39 fold medication overdose,” said Wachter. There were several missteps along the way, but Wachter says at the final stage a nurse saw the prescription for 39 pills. “She’s saying to herself ‘this is weird,’ she scans one pill and the barcode. And it says ‘the correct dose is 39 pills,’ and that was enough for her to go ahead. That’s a scary example of something that is very human, where we begin to turn our brains off.”

    Wachter is by no means anti-technology though. “There are physicians who say ‘bring back the three-ringed binder!’ and I think they are crazy,” he said. “We have to computerize and we’re at version 1.0 of this transition; we will get there.”

    Wachter said the field has to address current problems openly and honestly, and develop more user-centric technology.

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