Dr. Jeff Kane: High-tech and high-touch
A month ago, Dr. John Sievert published a Union column applauding the emergence of telemedicine, also known as telehealth. He described several successful instances of its use in his practice, and recommended it as a valuable practice aid during current social distancing.
I can’t help but agree. Ten years ago I observed a breast cancer support group that convened through video links. Participants checked in from widespread, medically underserved rural areas in Northern California. I found this early telemedicine event dramatically helpful.
Since then such technologies have advanced unimaginably. Today wheeled robots make rounds in hospitals. Like Mars landers, they’re operated by remote experts, and are remarkably effective in helping diagnose. And computers are now at least as accurate as physicians in identifying some cancers and other maladies. We want a prompt and accurate diagnosis, and these technologies fill the bill.
We older docs were trained in the traditional exam, which included observation, palpation (feeling organs), percussion (tapping with fingers — remember?), and auscultation (listening). So we did a good deal of touching before ordering tests. Now tests and scans are so sophisticated, accessible, and reliable that doctors’ physicals are often abbreviated and perfunctory, serving mainly as rituals to satisfy patients’ longing for the old touch style.
Just as a car requires both accelerator and brakes, we need to balance high-tech with high-touch. Undue focus on new technologies can result in a phrase we hear commonly these days, “unintended consequences.”
Misdiagnoses, for example. A recent medical journal related the case of an elderly woman admitted to a university hospital for evaluation of chest pain. All her tests were unrevealing. The attending physician, partially lowering the patient’s hospital gown, found the characteristic rash of herpes zoster, “shingles.” The resident, intern, and student all sheepishly admitted they had listened to the patient’s heart through her hospital gown, and, finding no abnormality, ordered batteries of expensive, intrusive tests.
A deeper criticism of touch deficiency is that it can annul medicine’s inherent magic. When I was six years old and bedridden with a strep infection, my parents summoned our pediatrician. (Yup, house calls were standard then.) He sat at my bedside, looked down my throat, and palpated my swollen neck glands. The burning stopped immediately. I don’t remember the penicillin shot, but I can still feel his soothing touch. I decided to become a doctor to learn this magic.
Touch is a placebo, of course, but a placebo is no small thing. It’s arguably the most potent medicine free of side effects. It tells us our suffering — and if we’re sick with anything, we’re suffering — is witnessed. Show me hardware or software that treats suffering more effectively than human contact and I’ll show you a unicorn. Today, when two-thirds of medical visits are for chronic — that is, incurable — disorders, a human relationship is indispensable.
And it’s as valuable to practitioners as it is to patients. According to physician-author Abraham Verghese, “…physician satisfaction is clearly tied to being connected with the patient. For most of us, that’s why we came to medicine. We didn’t come to sit in front of a screen.”
Jeff Kane is a physician and writer in Nevada City.
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