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Doctor Worries That We’re Creating ‘iPatients’

March 2, 2011
Written by: , Filed in: Diagnostic Imaging, Practice Management
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Lavishing too much attention on machines (including imaging machines) is hurting medicine, says Abraham Verghese, MD. Is he just an old fogey, or is he onto something?

In an opinion piece published Saturday in the New York Times, Dr. Verghese laments:

This computer record creates what I call an ‘iPatient’—and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record.

Dr. Verghese, a professor at the Stanford School of Medicine in California, echoes the observation that we discussed Monday here at RadiologyDaily.com about physicians being trained to examine the patient via imaging rather than their senses.

“Of course,” he says, “we still teach medical students how to properly examine the body. … But all that training can be undone the moment students hit their clinical years. Then, they discover that the currency on the ward seems to be ‘throughput’—getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge.”

As a result, he says, “we order more tests and subject people to the dangers of radiation unnecessarily.”

Why? “Imaging the body has become so easy (and profitable, too, if you own the machine),” Dr. Verghese says. “When I was an intern some 30 years ago, about 3 million CT scans were performed annually in the United States; now the number is more like 80 million. Imaging tests are now responsible for half of the overall radiation American are exposed to, compared with about 15 percent in 1980.”

Dr. Verghese speaks of the importance of the interpersonal rituals between doctor and patient, which, he thinks, machines can interfere with.

“Rituals are about transformation, the crossing of a threshold,” he says, “and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: ‘I will see you through this illness. I will be with you through thick and thin.’ It is paramount that doctors not forget the importance of this ritual.”

So, what do you think? Is he just indulging in “back in my day” nostalgia? Do his theories apply more to people of his generation than to iPhone/iPod/iPad-addicted children of technology? Or does he have a point?

Related seminar: Diagnostic Imaging Review: For Residents, Fellows and Radiologists

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