Thursday, March 25, 2010


The Panasonic Corporation recently announced it’s developed a medical robot that dispenses drugs to patients.

It will join its cousins, used increasingly in testing, diagnostic procedures, and surgery and other treatments. These machines can be miraculously useful, like the ones that perform thousands of blood tests in the time it would take a lab tech to check a single sample.

Sometimes, though, they tend toward the scary. Imagine a wheeled contraption that turns up at your bedside. (I’m not talking science fiction here; this actually occurs now in a few places.) This robot doesn’t look like a person except maybe for the physican’s face on the television screen, mounted where a head would be. The physician might not be in the hospital, though; she could be thousands of miles away. A camera in the robot transmits pictures of you to her. She operates controls to probe you here and there and perhaps zoom in on a lesion. She offers you encouragement, and then directs the robot to the next patient.

My neck hairs stand up when I learn of such stuff, I suppose, because I harbor a particular value that just won’t go away: human contact is a necessary and major component of healthcare. All else equal, the more contact, the better the healthcare. For the cost of a single drug-dispensing robot, a hospital could afford to hire several human beings to do the same work.

I’m indirectly involved with a breast cancer support program for women in northern California who live too rurally to participate in facilitated support groups. This program aggregates them into virtual groups with closed-circuit television. This arrangement is better than no participation at all, but one wonders: if technology didn’t breathe down our necks so fiercely, maybe we’d train local rural people to facilitate groups face-to-face. Nothing, nothing takes the place of actual contact.

The use of technology is a choice. Certainly we’re free to choose otherwise, but we are, after all, a technophilic society: we love gadgets. We’ve come to believe they’re more accurate, precise, objective, and, well, more glamorous than people are.

Contrast that with their job competitors, human beings, who are notoriously messy and unreliable. They get distracted, don’t show up, take breaks, need training, demand benefits, and make mistakes. (We downplay the fact that machines, having been designed and programmed by fallible humans, make mistakes, too, and they, like humans, need maintenance and eventually break down.)

I’m not sure whether I’ve become the curmudgeon I laughed at in my youth or whether healthcare actually is devolving. I’ve joked that the way things are going, eventually we’ll get our healthcare from vending machines, but these days I’m not laughing. The man who coined the term “virtual reality” a couple of decades ago, Jaron Lanier, has just published a book, You Are Not A Gadget: A Manifesto, in which he describes an ominous turn in the way we see ourselves. Young people, accustomed to flowing seamlessly between on-screen and actual realities, have “…a reduced expectation of what a person can be, and who each person might become.”

Is healthcare a kind of video game where one wins by diagnosing and treating according to the rules, or are greater, albeit invisible stakes involved? My spirits plummet when I see practitioners who turn their backs on patients in order to relate to medical records in their computer, and who don’t bat an eye at bedside robots. On the other hand, my spirits soar when I hear patients demand compassionate, personal treatment, knowing in their bones that gadgets are only gadgets, and that healing must flow from the human reservoir.

1 comment:

  1. I read a comment by you saying that trust was necessary in a patient/doctor relationship. Have you figured out how to develop that trust in the usual ten minutes that most primary care docs give (sell) to a patient?

    I'm sure there are exceptions but the only doctors I have met who aren't in a hurry are on a government or foundation salary. That includes military and VA doctors and all of those who work for Mayo or Cleveland Clinic and some faculty docs at universities.

    That tells me something about fee for service.

    Donald Kaye, Santa Fe NM