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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