Humanism in digital health: Do we have to sacrifice personal connections as we improve efficiency?
The human connection is threatened by medicine's increasingly reductive focus on data collection, algorithms, and information transaction.

Doctor by Brian A. Jackson/

If you follow digital health, Rachel King's recent Wall Street Journal piece on Stanford physician Abraham Verghese should be required reading, as it succinctly captures the way compassionate, informed physicians wrestle with emerging technologies -- especially the electronic medical record.

For starters, Verghese understands its appeal: "The electronic medical record is a wonderful thing, in general, a huge improvement on finding paper charts and finding the old records and trying to put them all together."

At the same, he accurately captures the problem: "The downside is that we're spending too much time on the electronic medical record and not enough at the bedside."

This tension is not unique to digital health, and reflects a more general struggle between technologists who emphasize the efficient communication of discrete data, and others (humanists? Luddites?) who worry that in the reduction of complexity to data, something vital may be lost.

Technologists, it seems, tend to view activities like reading and medicine as fundamentally data transactions. So it makes sense to receive reading information electronically on your Kindle -- what could be more efficient?

At the same time, it's hard not to resonate with humorist Joe Queenen, when he movingly writes, "People who need to possess the physical copy of a book, not merely an electronic version, believe that the objects themselves are sacred."

He adds, "Certain things are perfect the way they are. The sky, the Pacific Ocean, procreation and the Goldberg Variations all fit this bill, and so do books. Books are sublimely visceral, emotionally evocative objects that constitute a perfect delivery system."

I read this, and on many levels, agree. While I appreciate the convenience and immediacy of a Kindle, it doesn't compare with reading a real book to my kids before bed. At the same time, however, I'm sure that when the automobile first arrived, many swore never to forsake their trusted horse and buggy.

Is there something deep and emotional about books that Vulcan-like engineers are missing, or are they better able to embrace the future, while others resist change and cling atavistically to the past?

The issues in medicine, of course, seem strikingly similar: Technologists (and others) tend to see medicine as fundamentally a data exercise, where you seek to collect information and make a rational decision.

This perspective was evident in a notable dialog between Google's Eric Schmidt and the New Yorker's Atul Gawande, and was also an important feature of VC Vinod Khosla's vision of an algorithim-dominated healthcare future (herehere), a viewpoint that generated a significant response (here here, and here).

The electronic medical record has been a particular nidus of tension, as it seems to perfectly capture the transformation of medicine from a day when it was -- choose your descriptor -- [more personal/less robust] to a future when it will be [less human/more effective].

While, like Verghese, I intend to conclude that both technology and humanism are vital, I want to argue for something stronger than a Solomonic, "split the difference" compromise.

My sense is that most physicians, like Verghese, are all too aware that traditional record-keeping is terrible, and that vital patient information can be difficult to track down, much less share in a timely fashion with other providers. They would love a better approach, and would welcome intuitive technology -- although most would emphatically not place the majority of current electronic medical record options in this category.

I'm far less sanguine about the ability of engineers to recognize, appreciate, or value the "soft-side" of medicine, and fear most regard the patient-doctor relationship as an inefficient and antiquated tradition whose time has passed.

Indeed, many technologists view doctors themselves as an outdated profession -- like carriage drivers, or librarians (apparently the exemplar of choice among technologists). In Silicon Valley, there seems to be a palpable (though certainly not universal) disdain for physicians, who seem to be regarded as healthcare's fundamental problem rather than potentially part of an emerging solution.

For his part, Verghese embraces new technology, or at least, tries to. King writes, "Just as he's found ways to bring technology to the bedside and integrate it with patient care, he would like to find a way to integrate inputting data into electronic medical records more seamlessly with the actual exam."

"We have to find ways to not separate the two processes so much, and I'm not sure what the answer is," Verghese says, capturing digital health's greatest challenge and most significant opportunity.

I deeply believe medicine's value far transcends data collection and evidence-based decision making; there is a vital human connection that is threatened because it's so difficult to reduce to zeros and ones.

The danger is that if we don't find a way to recognize, express, and capture the value of the human connection in medicine, we are unlikely to preserve it, and it will become engineered out of healthcare - at least until an entrepreneurial, humanistic developer appreciates just how important and valued such connection can be.


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