Medical Writing Boon and Bane\':

Medical Writing

Boon and Bane': The increased use of technology in modern healthcare

At least your job can't be outsourced." When I first embarked upon my career in nursing, friends and family would always joke that since I worked in a 'hands on' occupation, I never needed to worry about my job being outsourced. Now, I am not so sure, when I see a doctor provide a second opinion to a colleague for a patient he has never met, as he gazes at the patient's chart on a screen on a computer that has been sent via a pdf file, only moments ago through email.

And this is only the beginning of the wonders technological communication in the field of medicine may promise. Computer-assisted systems may make robotic surgery common in the future, and already nurses are used to using computer-programmed medication drips, and receiving patient prescriptions via a computer-automated medication delivery process. Given how overburdened the medical system is already, such reliance upon technology seems like a necessity.

But I worry. I worry when I see some tired, stressed, and distracted nurses assume that computers can make no errors, and are not careful about checking the dosage of medications dispensed by automated systems or monitoring some of the devices that are computerized. It is only natural -- what must be done hands-on gets priority. But given that one of the foundations of nursing is fostering patient self-care, establishing a relationship with all patients, and treating a patient in the context of his or her family, culture, and individuated needs, I fear this reliance upon technology is threatening the highest aspirations about the quality of care nurses strive to give. Moreover, the greater the use of technology, the easier it is to assume that nurses can take on more and more patients, to the point the system breaks.

From my perspective, I think that the ability to access patient's vital data more easily is perhaps the greatest benefit I have seen technology bestow in my practice. There is a greater and greater array of medicines used today, and people are quite simply taking more medicines than ever before. This is partly a result of the graying of the population, and partly the result of simply more prescriptions being offered to patients eager to try out a new drug they saw advertised on television. Regardless, checking for medicines that are contraindicated is more important than ever before. Also, allergies are on the rise, and enduring that patients are not harmed by their prescribed cure requires the most complete information possible, and continual checking and double-checking of the patient's chart. The more complete the information about the patient and all of his or her past and present medications, the better.

But computers and charts are not infallible. I have heard horror stories -- of 200 units of a medication being given, rather than the prescribed 20, because of a misread dosage on an automated system. Of morphine drip programmed incorrectly, and only caught just in time before it administered a dangerously high dosage. Conversely, many a patient has been saved by a note on a file sent by email or fax about a blood type or allergy, from the patient's regular physician. These examples highlight that technology is always a tool, a way of enhancing human judgment -- we must not mistake it as a replacement for good nursing practice.

After all, the use of a computer is no substitute for a medical education. Anyone who works in a hospital can see this -- the increased accessibility of information through the Internet also means that patients often come in, convinced that they are suffering from a serious illness, allergy, or condition, based more upon a diagnosis Googled on WebMD, rather than upon the fact that they saw a doctor! If a computer alone was required to diagnose, everyone would have a degree!

Don't get me wrong -- I use technology every day in my life, and thank my lucky stars, and my patient's lucky stars, that it is so ubiquitous. When health care providers wish to communicate, the use of cell phones is invaluable, such as when an emergency case is being sent from another hospital. But all of the technology in the world cannot compensate for having a reasonable patient load per nurse. A nurse needs to talk to the patient, to find out about the individual beyond his or her constellation of symptoms during a hospital stay -- and check to see if he or she understands as well as simply receives a treatment plan upon discharge. Additionally, although a nurse might be able to contact a doctor at a moment's notice with a cell phone, it is essential that the doctor have the time to devote to the case to provide valuable expertise.

The shift to evidence-based medicine, or medicine squarely grounded in the scientific method, has both corresponded with as well as fueled the enthusiasm for the benefits of technology. But there is also a place for individualization, even intuition that technology cannot provide. While I do not live in fear of being outsourced, I do often wonder if some of my more technologically enthusiastic colleagues have forgotten some of the reasons that people enter medicine in the first place -- like helping patients achieve the best state of health possible, physically, emotionally, and psychologically.