Awesome Medical Tech, or Merely Obamacare Propaganda?

Ace of Spades linked to this NBC piece about the use of cell phones in medicine. The writer [Warden] and his brother were of two minds about the story, the former taking the position that it seemed pretty cool, the latter, that it was a piece of propaganda:

Did you correctly see this as nothing more than a slimey propaganda piece meant to condition the masses to accept and embrace less privacy, less one-on-one time with their doctor, and lower quality of care under Obamacare?

Embarrassingly, I didn’t until I read my brother’s response. Then it was obvious.

Honestly, I don’t see why it can’t be both, as well as being an 8 minute commercial for GE medical tech, courtesy of their wholly owned advertising division: NBC.
First, the propaganda. The writer’s brother is 100% correct to view every syllable from the mass media as a form of propaganda  That’s your safest bet, since what isn’t outright propaganda is usually just an exercise in applied ignorance in the interests of meeting a deadline, satisfying advertisers, and/or promoting an agenda.

However, that doesn’t mean you have to dismiss it all outright. It’s reasonable to ask if we’re being conditioned to accept less facetime with physicians and perhaps less effective diagnostic and treatment methods in the interests of saving money for Obama’s health care mess.

The answer is: probably.

Is that a bad thing?

Possibly not.

The tech on display is promising. I don’t usually like to brag about this, but I happen to sleep with an expert on medical imaging. When I first saw the doctor in the video reading a pocket ultrasound, I was kind of appalled, since I thought (incorrectly) all imaging was handled by radiologists. My wife told me cardiologists are, in fact, the people who read echocardiograms (ultrasound of the heart), but that there’s some controversy over other advances in imaging technology and when they should be used in place of more invasive procedures. Imaging is advancing to the point that, for example, cardiac PET scans can be used to diagnose certain cardiac issues which formerly might have required a cardiac catheterization (which is invasive and has inherent risks). With advances in CT, MRI, and PET, radiologists are starting play a role in diagnostic areas that were previously limited to examinations by cardiologists and other specialists.

Use of imaging rather than invasive procedures is a good thing, and it’s logical to foresee that imaging becoming smaller, more portable, and easier to use. It’s one thing, however, to have a cardiologist read your echocardiogram. But as these technologies become common features in GP offices, will we see unqualified physicians whipping out their pocket ultrasounds and saying, “eh, you look fine?” I’d say it’s almost inevitable.

We’ll also have to find a balance between reasonable home and personal use of this technology and the idea of people giving themselves ultrasounds. Home tech is completely reasonable and we already see it with blood pressure, glucose, and INR monitoring. More fully integrating these resulting data stream with doctors’ offices, and perhaps adding mobile-driven tech for things like EKGs and pulse-ox, is a good thing, and likely not very far off. Heck, Nintendo’s been talking about producing a pulse-oximeter for the Wii for a couple of years now.

The other question, then, is this: is less face time with a physician necessarily a bad thing? Are that many people really into sitting for an hour in a waiting room with old magazines while inhaling a viral miasma in order to get routine checks? People talk nostalgically about this mythical “relationship with your physician.” I haven’t had one of those since I was a kid, when we’d begin our appointment with the doctor sitting in his wood-paneled office behind a huge desk before retiring to the exam room. Obamacare didn’t kill that. A combination of HMOs and the demands of modern medicine (more tests, more prescriptions, more attention paid to well-care, more patients needing to be seen) did it in.

There aren’t enough physicians in the country to rebuild that paradigm on any kind of scale, and honestly, do we really need it? Sure, I have a nostalgic twinge for doctor’s appointments that were more like an encounter with a caring person than akin to an oil change and tire rotation. It was already a problem before Obamacare. Now that he’s shoving millions more patients into the same number of doctors’ offices, it’s only going to get worse. There simply aren’t enough doctors to meet the demands of the new system.

Modern medicine brings us better treatments, longer lives, and more comfort. The price for that is technology, and technology is–by its nature–inevitably dehumanizing.

And you know what? I’m okay with that. I don’t go to a doctor to chat about golf. I go to meet an expert on human health in order to correctly determine what’s wrong with my body. Certainly, a physician’s manner and familiarity with a patient can help make the encounter more pleasant and more effective. But the days of doctor-as-shaman are passing into memory. They no longer just listen to a cluster of symptoms and then deduce–Sherlock Holmes-like–the most reasonable plan of action. They have to send you for tests, and imaging, and find the right drugs or procedures. The doctor then pulls all the information together and, using expertise and experience, determines the problem and its solution.

Technology will ultimately automate more of this process, and make it easier to manage. Data sharing will enable physicians to have a more comprehensive picture of a patient’s complete medical history wherever that patient goes. PAs will be able to handle more of the frontline work (and it was a PA, not a doctor, who correctly spotted my father’s aortic aneurysm in time to save his life), with the doctor adding another level of experience and expertise. In a way, the doctor/PA relationship is akin to the priest/deacon relationship, and just as we see more and more deacons in service in the church, our medical care will involve more PAs as things go forward.

I don’t think any of it’s necessarily bad, just different. It’s also now inevitable after 60 million Americans looked at the last four years of ruin, demagoguery, war, and lies and said, Mm-hm! Gimme more of that!” This is our future. I don’t think it’s a good one, but I don’t think the technology is the thing we need to fear here. Medical technology saves lives. If I have a choice between a folksy old home-town doc with plenty a’  horse sense, and Dr. McCoy’s scanners and sick bay, I’ll take Bones every time.