for cardiac surgery and Duke University’s bone-marrow transplant center. Breast cancer patients seem to do best in specialized cancer treatment centers, where they have a cancer surgeon, an oncologist, a radiation therapist, a plastic surgeon, a social worker, a nutritionist, and others who see breast cancer day in and day out. And almost any hospital one goes to now has protocols and algorithms for treating at least a few common conditions, such as asthma or sudden stroke. The new artificial neural networks merely extend these lessons to the realm of diagnosis.
Still, resistance to this vision of mechanized medicine will remain. Part of it may well be short-sightedness: doctors can be stubborn about changing the way we do things. Part of it, however, stems from legitimate concern that, for all the technical virtuosity gained, something vital is lost in medicine by machine. Modern care already lacks the human touch, and its technocratic ethos has alienated many of the people it seeks to serve. Patients feel like a number too often as it is.
Yet compassion and technology aren’t necessarily incompatible; they can be mutually reinforcing. Which is to say that the machine, oddly enough, may be medicine’s best friend. On the simplest level, nothing comes between patient and doctor like a mistake. And while errors will always dog us—even machines are not perfect—trust can only increase when mistakes are reduced. Moreover, as “systems” take on more and more of the technical work of medicine, individual physicians may be in a position to embrace the dimensions of care that mattered long before technology came—like talking to theirpatients. Medical care is about our life and death, and we’ve always needed doctors to help us understand what is happening and why, and what is possible and what is not. In the increasingly tangled web of experts and expert systems, a doctor has an even greater obligation to serve as a knowledgeable guide and confidant. Maybe machines can decide, but we still need doctors to heal.
When Doctors Make Mistakes
T o much of the public—and certainly to lawyers and the media—medical error is fundamentally a problem of bad doctors. The way that things go wrong in medicine is normally unseen and, consequently, often misunderstood. Mistakes do happen. We tend to think of them as aberrant. They are, however, anything but.
At 2 A.M. on a crisp Friday in winter a few years ago, I was in sterile gloves and gown, pulling a teenage knifing victim’s abdomen open, when my pager sounded. “Code Trauma, three minutes,” the operating room nurse said, reading aloud from my pager display. This meant that an ambulance would be bringing another trauma patient to the hospital momentarily, and, as the surgical resident on duty for emergencies, I would have to be present for the patient’s arrival. I stepped back from the table and took off my gown. Two other surgeons were working on the knifing victim: Michael Ball, the attending (the staff surgeon in charge of the case), and David Hernandez, the chief resident (a general surgeon in his final year of training). Ordinarily, these two would have come to supervise and help with the trauma, but they were stuck here. Ball, a dry, cerebral forty-two-year-old, looked over at me as Iheaded for the door. “If you run into any trouble, you call, and one of us will peel away,” he said.
I did run into trouble. In telling this story, I have had to change some details about what happened (including the names of those involved). Nonetheless, I have tried to stay as close to the actual events as I could while protecting the patient, myself, and the rest of the staff.
The emergency room was one floor up, and, taking the stairs two at a time, I arrived just as the emergency medical technicians wheeled in a woman who appeared to be in her thirties and to weigh more than two hundred pounds. She lay motionless on a hard orange plastic spinal board—eyes closed, skin
Still, resistance to this vision of mechanized medicine will remain. Part of it may well be short-sightedness: doctors can be stubborn about changing the way we do things. Part of it, however, stems from legitimate concern that, for all the technical virtuosity gained, something vital is lost in medicine by machine. Modern care already lacks the human touch, and its technocratic ethos has alienated many of the people it seeks to serve. Patients feel like a number too often as it is.
Yet compassion and technology aren’t necessarily incompatible; they can be mutually reinforcing. Which is to say that the machine, oddly enough, may be medicine’s best friend. On the simplest level, nothing comes between patient and doctor like a mistake. And while errors will always dog us—even machines are not perfect—trust can only increase when mistakes are reduced. Moreover, as “systems” take on more and more of the technical work of medicine, individual physicians may be in a position to embrace the dimensions of care that mattered long before technology came—like talking to theirpatients. Medical care is about our life and death, and we’ve always needed doctors to help us understand what is happening and why, and what is possible and what is not. In the increasingly tangled web of experts and expert systems, a doctor has an even greater obligation to serve as a knowledgeable guide and confidant. Maybe machines can decide, but we still need doctors to heal.
When Doctors Make Mistakes
T o much of the public—and certainly to lawyers and the media—medical error is fundamentally a problem of bad doctors. The way that things go wrong in medicine is normally unseen and, consequently, often misunderstood. Mistakes do happen. We tend to think of them as aberrant. They are, however, anything but.
At 2 A.M. on a crisp Friday in winter a few years ago, I was in sterile gloves and gown, pulling a teenage knifing victim’s abdomen open, when my pager sounded. “Code Trauma, three minutes,” the operating room nurse said, reading aloud from my pager display. This meant that an ambulance would be bringing another trauma patient to the hospital momentarily, and, as the surgical resident on duty for emergencies, I would have to be present for the patient’s arrival. I stepped back from the table and took off my gown. Two other surgeons were working on the knifing victim: Michael Ball, the attending (the staff surgeon in charge of the case), and David Hernandez, the chief resident (a general surgeon in his final year of training). Ordinarily, these two would have come to supervise and help with the trauma, but they were stuck here. Ball, a dry, cerebral forty-two-year-old, looked over at me as Iheaded for the door. “If you run into any trouble, you call, and one of us will peel away,” he said.
I did run into trouble. In telling this story, I have had to change some details about what happened (including the names of those involved). Nonetheless, I have tried to stay as close to the actual events as I could while protecting the patient, myself, and the rest of the staff.
The emergency room was one floor up, and, taking the stairs two at a time, I arrived just as the emergency medical technicians wheeled in a woman who appeared to be in her thirties and to weigh more than two hundred pounds. She lay motionless on a hard orange plastic spinal board—eyes closed, skin
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