Robert was the picture of health. He had run eight marathons and finished countless 5K and 10K races. He tracked everything from sleep to food intake, logging his exercise parameters religiously.
A seven minute mile was a routine workout for Robert. But over the course of a few days, he noticed that he felt more winded during his run. One morning, when he awoke and checked his heart rate variability (HRV), it revealed a unusual drop. His VO2 max had also fallen considerably. So Robert sent an email to his physician, sharing his data and concerns. His doctor was also a runner, and loved when his patients armed him with data that enabled him to treat them.
Later that day, during his cardiac catheterization, Robert’s physician let him know that his tracking activities and insight had likely saved his life.
Two houses down from Robert lived Linda. Linda was a housewife and because she was so busy tending to her children’s needs, she had little time for exercise. She did love gardening, though.
One day, Linda was kneeling down in the grass. When she stood back up she felt a snap in the back of her knee. The pain lessened on its own, but at her annual physical the next week, she mentioned the episode. An MRI revealed a medial meniscus tear. She was refereed to a specialist. No examination was performed, nor was it discussed how this tear was affecting her, but surgery was recommended. Linda was feeling better; her daily activities were unchanged. But because her specialist recommended surgery, she signed up.
The procedure went well, by any standard measure. Yet Linda’s pain was worse within a week. She developed deep vein thrombosis, and the swelling in her leg has not improved since. Now, Linda is limping around, and remains on anti-coagulants to treat the DVT that almost killed her.
Technology will cure what ails healthcare; technology will disrupt healthcare – the headlines are everywhere, littering the digital landscape in 140 characters or less. They are neither – and both – right for one simple reason: context.
In the proper context – such as Robert’s – technology can be liberating, workflow-enhancing, and life-saving. But all too often, the context looks more like Linda’s, where the digital data we have is not combined with the verbal information we get about how the condition is actually affecting the patient. As a result, we treat numbers or MRI findings, not people. And this can easily end up bending the cost curve or the morbidity curve the wrong way. It’s happening now.
There is no question that technology plays a powerful role in evolution of our tattered and dysfunctional healthcare system. But we should not accept it at the expense of simply being a good doctor. Good doctors listen, communicate, make themselves available, teach, and are empathetic. These are the basic skillsets that enable us to treat a whole person, and not simply their laboratory or MRI findings. They are what further enable us to determine if a certain diagnosis requires treatment or observation. Just because we have a scalpel and 3T / 3D technology to see what’s torn doesn’t mean we always need to use them.
Howard Luks, MD, is an orthopedic surgeon with offices in Westchester and Duchess Counties. He is an associate professor of Orthopedic Surgery at New York Medical College, and serves as chief of Sports Medicine and Arthroscopy at University Orthopedics, PC and Westchester Medical Center. He is a frequent contributor to The Doctor Blog. Follow him on Twitter @hjluks.