Saturday, May 19, 2012

The Game's Afoot

The Game's afoot ~ Shakespeare

There is a fervent hope in patients to find trust in their physician and as a consequence of that, faith in their management. The results of therapy are partly the human “thing” and partly the created salve. If you have doubts figure the 20% benefits that arise from placebos. Or in psychiatry over 40-50% of benefits can be derived from placebos added to a good verbal session. So medical care is not all in the machines, pills and injections. There is a strong component of the psyche involved. A good bedside physician is able to cure a lot more maladies within the limitations of his knowledge and available tools as compared to a “super-duper expert.” That is why the need for the primary physician remains paramount to patient care.

After all why do we go to the physician? We seek help from him or her for a malady that afflicts us. We don’t go to him to socialize, nor do we go to shoot the breeze, although during the process of evaluation personal discussions occur and they help immensely in differentiating the etiologies and finding the human connection.

I came across a letter the other day. It was written the old fashion way, in a hand-written cursive, single-lined ink. The handwriting leaned this way and that but was clear. The words scratched off here and there but they had meaning. The sentences ran into each other but they held emotions. The paragraphs were riddled with hanging participles but they had clarity. It was a letter from the mother of a patient. It was sad. It was emotional but it was also factual. The letter described the last days of her son. She had unburdened herself of the weight of a million invisible tons. It created tears that had to be held in check. It made for the bubble of emotion that can easily ride its own wave of despair, that had to be managed. It was very sad. He, the son, had died after a short battle with an undisclosed illness. He had previously had a malignant Lymphoma that was cured through treatment and then this ugly virus had stepped in and churned the immune defenses until nothing was left. He was forty years old at the time of his death. I must have held that letter in my hands for a long time. His face came flooding back into my mind’s eye. His easy smile and the colorful blush of his twenty-something gift of wonder flashed before me. We had talked of baseball. We had talked about cars, about his work, about his future, about his life. We had talked about his mother and his family often, I knew them all well. And yet here it was, the end. The sum total of a once beautiful life that had touched so many hearts and minds, snuffed –relegated to the forests of memory.

She wrote how he had always talked about our conversations and how he found the courage to do what he had done in his life. The goals he had achieved. The progress he had made as a person. In the end the last sentence struck me, “he attributed his optimism to you.” Nicer words then that could not have been written on paper by a grieving mother to her son and daughters’ physician. There was a relationship of trust and an element of faith with which he had fought and won the earlier battle but died in the course of the long war.

I remember walking into a patient’s room and saw the resident with his face buried in the computer tablet asking questions and inputting information, never once connecting through an eye contact. The resident seemed completely at peace with his fingers flying over the tablet crossing the boxes and using short-cuts for the verbose glossary that made the electronic record. There were too many digital words with little meaning and none to satisfy the need of the patient.

The world of medicine is in turmoil. We know not what we do nowadays. We promulgate to promulgate, we strategize to strategize, we plan to plan, but we never actually do. We hide behind the comforts of technology so we may not expose our fragile senses of self. The human connection of “how are you?” is changed to “and what are you here for?” Instead of holding a hand or placing a comforting one on the shoulder, we write, “patient is emotional.” What have we become? Is this the evolutionary face of an intellectual society, or the decline of an aging dinosaur?

And so, from hour to hour, we ripe and ripe,

And then, from hour to hour, we rot and rot;

And thereby hangs a tale.' ~ Shakespeare

And so I thought, what if we were to connect C3P0’s wires to IBM Watson’s brain and give “it” the “provider” hat all the technology experts and some in the ivory towers are proposing, that will definitely satisfy the pundits. What will be the outcome? Will C3P0/Watson ask so “how was the game last night?” or “did you see that homer off the right field wall?” or “how are sales of the new 2012 model car?” No I don’t think C3P0 would be able to connect at that level. Maybe “it” will answer with “the game was good Mr. Jones.”

Now supposing C3P0 makes a wrong diagnosis from its list of differentials, it might address the mistake like HAL 9000 did in 2001 Odyssey, “It can only be attributable to human error.” And if the programmers at IBM or those for C3P0 decide to take it offline, it may answer like HAL 9000, “This mission is too important for me to allow you to jeopardize it.” And its assertion of its importance to the Healthcare issue of providing the ultimate best care to patient, here is what it might mimic HAL9000 again, “Let me put it this way, Mr. Amor. The 9000 series is the most reliable computer ever made. No 9000 computer has ever made a mistake or distorted information. We are all, by any practical definition of the words, foolproof and incapable of error.”

So we are head long into this love affair for the higher artificially intellectual endowed technology with, as usual, our eyes closed. And placing more and more reliance may ultimately lead to a certain self sufficiency that it (the computing device) might give a retort back, but the damage would already have been done to countless by then and the need for unplugging and reprogramming so vital to the future health of humans, would invite a similar remark in HAL 9000’s firm and decisive one, “I'm sorry, Dave. I'm afraid I can't do that.”

The human connection that is being undermined steadily today for fiscal and other reasons will and already to a certain extent, has unintended consequences. We may choose to keep the blinders on firmly over our eyes, but the inescapable future sits defiantly planted before us. Who will “feel” the empathy? Who will ask about baseball? Who will… but I digress, for that is not in the outline of our current or near future system where everyone is ogling over the latest and greatest invention and freest of freebies. They are more concerned with what is the written word, however inaccurate or untrue, then to the reality of the existing facts. Today, the elitist use of the word “sympathy” that supercedes the down-to-earth expression of an act of  “empathy” by a commoner. While the decision makers “stand like greyhounds in the slips, straining upon the start,” they are oblivious or unconcerned about the forced course of history their actions will enable, for they have “Disguise(d)  fair nature with hard-favour'd rage.”

When in the why and the wherefore is neither rhyme nor reason? ~ Shakespeare

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