This year’s theme at the American Hospital Association Leadership Summit in San Diego was innovating in a time of change, but for the closing keynote speaker, some innovations have robbed physicians of their ability to connect with patients.
Amid innovation and technological advancement, it is easy to forget there is a body attached to the screen, said Abraham Verghese, M.D., a senior associate chair at the Stanford University School of Medicine, who closed out the 25th annual meeting.
“I do think there’s a danger that we can lose sight of the patient, and technology becomes technology for its own sake,” said the New York Times best-selling author. “I do think innovation in health care is going to come from informatics, from scaling up technology, but it has to come from the sort of progress we saw from the mainframe computers to our iPhone. Frankly, we aren’t seeing that kind of evolution in the delivery of care,” Verghese said.
What we are seeing, according to Verghese, is a “4,000-click-a-day problem” that has led to high rates of burnout among physicians, nurses and other caregivers. An emergency department doctor averages 4,000 clicks in one day, and “we can do a lot better than this,” he said.
An estimated 50 percent of physicians, by some measure, are depressed, Verghese said. “If that’s true, this is not an individual problem, it is a systemic problem,” he added.
Verghese, a practicing physician, went on to describe a meaningful interaction he experienced with a patient suffering chronic fatigue. The first visit consisted of listening to the patient’s story. During the second visit, the patient's history again was the topic, but Verghese began examining the patient. “An interesting thing happened,” Verghese said. “The patient began to quiet down, and we got into a dance or performance. The patient said, ‘I’ve never been examined like this before,’” Verghese told the audience.
After discussing the encounter with an anthropologist at Stanford, Verghese came to the realization that the interaction between a physician and a patient could be defined as a ritual. Rituals (funerals, weddings, bar mitzvahas) are all about a transformative experience. And it’s up to the physician to achieve that transformation, Verghese said.
Patients can tell when this is done well or not, he said. “If you do [a poor job] and stick your stethoscope on the paper gown or are a meaningless part of their day, they’re on to you — they know that they’ve been shortchanged,” he said.
Finding a better way to integrate technology into care and thinking about incorporating the patient experience into this technology are areas that would bring the human aspect back to the physician-patient relationship, Verghese said.
“I can get cash anywhere in the world with the swipe of a card,” he said. “Yet I cannot get my electronic medical record from my hospital to talk with ... the clinic that’s affiliated — that’s the sort of problem that technology hasn’t solved.”
The answer to that problem may come in the form of artificial intelligence and machine learning — if it’s done thoughtfully, Verghese said.
“AI can help a great deal,” he said, but added that “the nature of deep machine learning sometimes magnifies existing prejudice and inequalities in the system.”
We must therefore think of HI before AI, Verghese said: “Human intelligence before artificial intelligence. Apply it in ways that matter for us on the front line.”