Saturday, September 10, 2005

Medicine and Technology AND Katrina

In med school there were dozens of times when our professors emphasized that a diagnosis is composed of 80-85% history and physical examination and 15-20% laboratory findings. We were given cases where the laboratory results apparently were normal but physical findings suggested otherwise - it was hard to act on the physical findings when it wasn't supported by the lab results. But that was how we were trained.

I came across this essay in the New York Times: Practicing Medicine in the Dark, on the Edge. It was about the working environment of Healthcare workers in the areas hit by Hurricane Katrina.

"You end up trusting more in your judgment," she said, "relying less on the backup tests you do sometimes for medicolegal reasons. Over time, you know, we all have a fair amount of experience to tell us what's going on."

But the truth is that the way we deliver care has come to depend extensively on technology, not just the imaging miracles of radiology and the subtleties of serology, but on the whole electronic network of communication and commerce that keeps our world turning.

This is something Filipino doctors have - a lot of experience in trusting their judgement. Almost half of our population can be considered poor and unable to gain access to what other countries counsider as 'basic' health care facilities. Our health insurance system - well, it sucks! But we have to make do with what we have.

Even in the kind of relatively low-tech, relatively old-fashioned medicine I practice - primary care pediatrics - there's an inexorable tendency to move away from relying on your own medical skills and get the extra test.

And there is no question that the technology, while it makes it possible to look inside a patient, to quantify ever more obscure shadowy presences in a patient's bloodstream, also tends to change the way you do - or do not - look at your patient.

You trust your own eyes and ears a little less. You look for confirmation from machines before you act. You ask clinical questions partly because you know they can be answered and you want to "document" the answers.

I took up BS Medical Technology before going to medicine. During my 4th year - internship - I realized that most of the work of MedTechs involved machines. And I realized, you don't need a college degree to do this work. Highschool graduates could be taught how to run these machines. I don't intend to undermine the medical technologists out there but take a look at kids these days - they can easily adapt to technology... then take a look at how difficult it is to teach an adult how to send text messages.

Eventually, hopefully... please God, let it be soon, our country will catch up in terms of technology in healthcare. I hope that we do not follow the footsteps of our Western counterparts. We have something they don't have - a clinical eye! Add that to modern technology and we have something we can be proud of - world-class Filipino doctors! (not just technologists)

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