By Jennifer J. Salopek
In his new book, due out on April 7, Bob Wachter, MD, tackles the “hope, hype, and harm” of the complicated relationship between health care and technology. In The Digital Doctor (McGraw-Hill), he offers an overview of the development of health care information technology over the past three decades, its successes, failures, and challenges, and concludes that “technology will upend the lives of doctors and patients.”
Wachter’s road to his current position as observer of these developments was a circuitous one. Raised on Long Island by a stay-at-home mom and a clothing manufacturer dad, he majored in political science at the University of Pennsylvania. “I was always interested in the intersection of systems and people, and realized that by studying medicine I could actually combine the two into a career that was reasonably holistic,” he says. He stayed on at Penn for medical school.
For residency, Wachter ended up in San Francisco on a whim. “California was definitely not on my life plan, but I fell in love with the culture and the structure of the program when I visited,” he says.
The culture of academic medicine has changed for the better over the past 30 years, Wachter believes: “People are more attentive to work-life balance, the hierarchies are less steep, the people are less formal and haughty. The dominant culture is more democratized. The gender balance has changed things. It’s definitely more sympatico with the way I approach life.”
Perhaps best known for his work involving residents in quality and safety initiatives, or for coining the term “hospitalist,” Wachter has published other books. For this one, however, he undertook a more journalistic approach, interviewing nearly 100 people, from pilot Captain “Sully” Sullenberger to hospital chief innovation officer John Halamka.
He believes that the health care industry is ill-prepared for the shift. “This is an extraordinary moment in medicine. Technology has changed the nature of our work, but we have given insufficient thought to the implications of that change: What else changes? What are the benefits and the harms? How do we mitigate the harms?”
One such area of potential harm is relationships, both with other professionals and with patients. Now that physicians and trainees are no longer tethered to the wards, there’s a significant loss of human-to-human interaction and the “serendipitous relationships” that cropped up with nurses, case managers, and other people.
Citing Abraham Verghese’s iPatient, Wachter says, “As much as we will always struggle with illness as a deeply human endeavor, we train future doctors to distance themselves. Now that all of the data is in digital form, we scurry out of the exam room to do the ‘real work’ on the computer.”
In his own program at UCSF, Wachter sees a dawning recognition of the loss. “Our trainees and junior faculty went into this field to take care of people, and they are actively working to reclaim lost ground. It’s not true that young people care only about screens. They are deeply troubled by the fact that they have to spend so much of the day on the computer. They know that the only way to solve this tough problem is to make the systems more usable, and to specifically tackle the loss of human interaction and bring it back.”
Having both recently attended a conference on patient engagement, our conversation turned to what actually is meant by the term: Is patient engagement a technology solution or a competency to be developed in physicians? Can it be both, or can the latter be facilitated by the former?
“The fact that the machine is now the dominant locus of our work has a material impact on training and culture,” Wachter says. “How do we train people to focus appropriately on the human dimensions of care, when we recognize that a large part of their day will be spent in front of a computer screen, looking up facts and figures and a digital incarnation of the patient? Unless we focus on that as a specific competency, we won’t get it right.”
The challenge echoes in medical schools and teaching hospitals across the country as they struggle to implement, integrate, leverage, and teach technology simultaneously.
“We have to figure out how to mint empathic, humanistic physicians who have the right training and the right values and the right culture in the digital environment of modern America, and who see digitization as one of many tools to accomplish the core goals. At the level of what a curriculum does for students or for residents—what we want future doctors to look like—we have to figure out how to do it all in the digital environment,” Wachter concludes.