Blog | Friday, February 21, 2020

There is too much technology in medicine

As promised, here is the continuation of last week's post where I discussed the loss of physicians' diagnostic skills which have been largely replaced by technology.

Of course, the medical community celebrates the miracles that technology has brought us. Innovation has improved our lives and will continue to do. On this issue, there is no debate. But, as with many advances, there is a cost. Here's my take on the downsides of the technologization of the practice of medicine.
• Overreliance on technology has cost zillions of dollars.
• Much of the overdiagnosis and overtreatment in our health care system, which I have decried on this blog, is caused by medical technology.
• Technology has strained the doctor-patient relationship. It is often easier to order a scan than to have a deeper conversation with patient who needs advice and counsel, particularly when physicians' schedules are jammed.
• CAT scans and their ilk regularly find unrelated “abnormalities” that would remain dormant for life, but now assume a life of their own as doctors must pursue them.
• Technology is not perfect, even though we all tend to regard it as the Holy Grail. A negative test result may blind us to the truth if we are not vigilant. A patient with stomach pain and a normal CAT scan can still be in deep trouble.
• Patients have taken heed of our technology obsession. They regularly ask their doctors for testing that they may not need. Every doctor has had a patient facing him insisting that a CAT scan be done. The public understandably believes that more testing is better medicine. Of course, this is false premise but try convincing a patient and their family of this. I know from my own family; they don't get it and the medical profession and our payment system is responsible for it. (Patients are more enthusiastic for testing that the insurance companies will pay for)
• There are financial conflicts of interests that drive the overuse of technology. Yes, medicine is a business and we would should expect that the normal forces of profit seeking are operative.
• Technology has not only eroded physicians' physical exam talents but has also diminished doctors' skill and enthusiasm in obtaining patients' medical history, the important narrative that the patient communicates to the physician.

I often hear and read presentations of patients' medical history where the third sentence is “… and the CAT scan showed …” This premature intrusion of a technology result, a physician spoiler, immediately prejudices the doctor who should have been given time just to hear the patient's own story. If you are told in advance of an important future development in a mystery story, will you still read the book as carefully as you would have otherwise? The danger for doctors who are given a sneak preview of events is that we become less attentive and vigilant which can lure us into false passages.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.