Here’s the question: Can technology advance compassion, understanding, partnership and professionalism?
Parallel studies of large cohorts of patients and their physicians in the late 90’s in the U.S., U.K., Germany, South Africa, Japan and Canada revealed consistent agreement on the primary definers of a successful patient-physician relationship. They were compassion, understanding and partnership. Patients also consistently listed three deliverables that they valued highly as an output of the relationship – the processing of fear and worry; the reinforcement of important family and community linkages; and the promotion of hopeful futures for their patients. (1)
What is striking is that the values and attributes that others have used to define “professionalism” are perfectly aligned with the qualities that caregivers and their patients define as integral to a successful relationship with each other. Enter now advanced information technologies. Few would deny the benefits of these new resources on behalf of understanding and partnership. But what about compassion. Can technology reinforce compassionate care and committed human relations?
Back in 1983, Dr. John A. Benson, Jr., then President of the Board of Internal Medicine, voiced these words when questioned about technology’s impact on the patient-physician relationship. ”There is a groundswell in American medicine, this desire to encourage more ethical and humanistic concerns in physicians. After the technological progress that medicine made in the 60’s and 70’s, this is a swing of the pendulum back to the fact that we are doctors, and that we can do a lot better than we are doing now.” (2) He accurately described the mood then, and for most of the 20th century, of clinicians toward technology, a complex love-hate relationship that has rejoiced and cheered our progress, while struggling to accept and master change in a manner that would avoid driving a wedge between them and their patients. (3)
It is fair to say that, as the health consumer movement has matured over the past 25 years, and physicians have moved away from paternalism to partnerships and team based approaches to care, that outright resistance and abject fear of technology has progressed to and beyond grudging acceptance. In part the people, and the people caring for the people have developed computer skills together, pursued broadband and wireless connectivity together, and discovered the value to personalized and customized computer search engines together.
As this has occurred the specialty of Medical Informatics has risen to legitimacy within the Medical hierarchy, and its leaders have reinforced the need to advantage technology and informatics in support of humanistic care. (3) One such voice is that of Warner V. Slack, who heads the Center for Clinical Computing at Harvard Medical School. No “Johnny-come-lately” to the field, his first published paper in Medical Computing appeared in the New England Journal of Medicine in 1966. (4) His book, Cybermedicine: How Computing Empowers Doctors and Patients for Better Health Care, is considered a classic, and argues, as Health Informatics expert Kevin Kawamoto from the University of Washington has said, that “Computers can be mutually beneficial for both the patient and the health care provider”. (5)
If we have managed to move as caregivers from resistance to acceptance of technology in health care, I would suggest we have not moved far enough. As I stated in a reference paper as chair of the technology sub-committee for the National Commisssion for Quality Long Term Care: “In embracing technology in Medicine, we must view it as both assistive and transformational.The revolutionary strength of modern information and scientific technologies is that they ignore geography. In so doing they allow us to reorient and connect beyond the limits of a range of barriers whether they be physical, social, financial or political. The danger is not in over-reaching but in under-reaching. Our vision must be sufficiently forward looking and expansive to challenge technology innovators. Where are the ‘killer applications’ that would allow lifespan planning to move us ahead of the disease curve? How can we target technologic advances in health to first reach our citizens most at risk? How do we, in powering the health technology revolution, broaden our social contract to include universal health insurance? How do we unite the technology, entertainment, and financial sectors (previously locked out of the health care space) with the traditional health care power players, and incentivize them to work together to create a truly preventive and holistic health delivery system that is equitable, just, efficient, and uniformly reliable? How can each citizen play a role in ongoing research and innovation, and help define lifelong learning and behavioral modification as part of good citizenship? What can corporate America do to advance health information infrastructure and in “doing good,” do well financially, serving Main Street as it serves Wall Street? ” (6)
Powering up the vision of course demands resources. On August 20, 2009, the US Government announced $1.2 billion in new grants to advance the “meaningful use of electronic health records by all individuals in 2011, and to support the development of mechanisms for information sharing through EHR’s in the United States”. (7) Avi Shachak and Alejandro Jadad, in their February 3, 2010 commentary in JAMA help connect the dots between “sufficiently powered vision” and “meaningful use”. Their 7 objectives? Tools to promote health; Integrated and interoperable components; Incorporation of multi-media; Support of virtual interactions; Integration of social networking; Promotion of optimal outcomes, resource utilization, and policy development; Open and collaborative systems, free of unnecessary concerns about privacy. (7)
Health Information leaders of the 21st century are becoming more revolutionary. Were they to achieve at their full capacity, our health care system would transform and re-center around relationship based care, cementing the people to the people caring for the people. If we were to do that we would see improvment on 10 different fronts simultaneously: access, efficiency, team care coordination, multi-generational family linkages, inclusion of informal family care givers in the health care team, targeted interventions for vulnerable populations, informed mutual decision making, lifespan health planning, evidenced based personalized care, and palpable presence of physicians, nurses and care team members in the home. Paul Dinsmore, in the AMA Book of Project Management said, ” … designed properly…technology can be a great gift to humanity.” (8) We no longer can afford to simply accept technology. We must embace “techmanity” as a major component of “advanced professionalism”.
For Health Commentary, I’m Mike Magee.
1. Magee M.”The Patient – Provider Relationship” in Connecting with the New Healthcare Consumer, McGraw Hill, 1999. http://openlibrary.org/b/OL9830802M/Connecting_with_the_New_Healthcare_Consumer
2. Nelson, B. Can Doctors Learn Warmth? New York Times. September 13, 1983. http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F06E6DF1038F930A2575AC0A965948260
3. Shortliffe, EH. Doctors, Patients and Computers: Will Information Technology Dehumanize Health Care Delivery? Journal of the American Philosophical Society. November 12, 1992. Vol. 137 (3): 390-398.http://www.u.arizona.edu/~shortlif/Shortliffe-CV.pdf
4. Warren V. Slack Bibliography. http://informatics.caregroup.harvard.edu/people/wslack/
5. Kawamoto, K. Computer Technology in Health Care Settings. The Journal of Education, Community, and Values. May-June, 2003. http://bcis.pacificu.edu/journal/2003/04/kawamoto.php
6. Magee, M. Fully Leveraging Technology to Transform Health Care. Technology Sub-Committee, NCQLTC. http://docs.google.com/Doc?docid=dc3ppvhb_60cw5zqd&hl=en
7. Shachak A, Jada AR. Electronic Health Records in the Age of Social Networks and Global Communications. JAMA. 2010; 303 (5): 452-453.http://jama.ama-assn.org/cgi/content/short/303/5/452?home
8. Dinsmore, Paul C. and Jeanette Cabinis-Brewin, Eds. AMA Handbook of Project Management http://bus.safaribooksonline.com/0672326140/ch08lev1sec6, http://www.amanet.org/books/catalog/0814472710.htm