Technology and Humanity : The Janus of Health Reform, As Portrayed in the Sunday New York Times

February 27, 2011 -Janus was a Roman God with two faces. Each face looked in opposite directions. This suggested vigilance and fair-mindedness.

I evoke the name of Janus because because today’s Sunday New York Times contains articles by two of my favorite writers.

• Steve Lohr, a journalist, The Time’s commentator of innovation, whose column appears every Sunday.

• Abraham Verghese, MD, a Stanford professor of medicine, who writes regularly about the use and abuse of medical technology.

General George Patton was once asked if he read the Bible. He replied, “Every G—D--- Day”! Likewise, I read the New York Times “Every G—D--- Sunday!” To me, the Times is the Bible of American liberalism. I like to know what its business and health care staff are saying.

Steve Lohr is saying a universal interoperable electronic medical records system is a vastly ambitious idea that has a long way to go. In an excellent piece, “Carrots, Sticks and Digital Health Records, “ he describes how and why government is spending an estimated $27 billions in incentives to convert doctors and hospitals to adopt electronic doctors by 2015.

After that, doctors who serve Medicare and Medicaid patients will be financially penalized who don’t meet use and reporting rules for electronic records. It’s a huge gamble. Big organizations – like Mayo and Kaiser and the Marshfield Clinic – are on board. But small practices are not. Less than 30%, Lohr’s figure, now use digital records. A year or so ago, a New England Journal survey, put the estimate for “full-use” of EHRs at less than 10%. I suspect the NEJM is closer for "full" EHR use.

Verghese’s article, “Treat the Patient, Not the CT Scan,” is more chilling. He says 80 million CT scans are now being performed, often sacrificing the time-honored ritual of listening to or examining the patient and endangering the patient to unneeded radiation.

In his opinion, medical technology can blind doctors to the needs and problems of the sick. He tells the story of of a woman who arrived in the E.R with seizures and breathing difficulties. She had been seen by multiple doctors over the course of the years before her ER arrival.

A CT scan in the ER revealed multiple breast masses, which should have been easily palpable on physical exam. In his Verghese’s word, “ I got to see the CT scan: the tumor masses in each breast were likely visible to the naked eye – and certainly to the hand. Ye they had never been noticed.” He added that “I am collecting stories like this from all over the country.” A thorough physical exam is a comforting ritual for patients - and can pick up disease before technological intervention.

Janus would understand: technology and humans represent the two faces of medicine