In my very early years of practice, an older patient named Cora would call me at home, usually late Sunday night after she had consumed an unknown quantity of beer. She would always tell me about some event that had "set her low back off" and that she wanted to be sure I could see her the next day.I would listen, reassure her that I could "fit her in" (among the eight or 10 patients I might have had scheduled in those days), and she would then hang up abruptly. This went on for a few years. I was young and found the ritual to be amusing and probably harmless, if not professional.
But now I have e-mail. In the spirit of better communication, I have offered my patients an "Ask the Doctor" e-mail opportunity. I knew that I would not be reimbursed for this time, but thought that the access would encourage goodwill.
My first e-mail was from Kara, an obsessive-compulsive patient who asked me, once again, to explain why her vertebrae go "out." This dialogue soon became pointless, since every time I provided an answer, she came up with at least two more questions. Which meant that if I offered two possible answers, I might receive four more questions. Consequently, 200 answers could generate 400 questions.
In case you've been wondering, the topic of this article is actually technology and how it's value can be perplexing, especially during a day in the office. The cellphone is a good example, although it is too easy a mark for humor, much like air travel is to stand-up comedians. When I look around the corner into the reception area of my office, it is obvious that I don't need many magazines. The patients are all staring into their cellphones. I have given up asking patients to put their phones on "vibrate" or shut them off in the treatment room, because I have actually grown to enjoy the variety of ringtones I hear every day! The existential oddity of an elderly woman on a walker, having her cellphone ringtone play "Born to be Wild" can make my day.
Colleagues, have you ever had a patient on the treatment table, adjusting them, when they answer the cellphone in their pocket and start talking? I have. It's difficult to do a cervical manipulation when the patient has a smartphone to their ear. If this has happened to you, then it's time we all set some limits.
During a conversation with a new patient, I was told that an orthopedist had already gone over his spinal X-rays with him. "Would you like to see them?" he asked. I expected him to whip out a digital CD, but instead he whipped out his iPad. He had taken pictures of his X-rays with his cellphone, as they hung on a view-box, and imported them to his iPad. The quality was very good, and I began to understand life was not going to be the same.
Technology has been a blessing in health care in many ways. I'm happy that X-rays and MRIs can be put on digital discs, since I don't have to worry about losing them. But I wish all the hospitals and imaging centers would use the same software. Whenever a patient brings me a CD of their MRI, and wants me to look at it and discuss the images, my hands start to tremble when I slip the disc into my laptop. That's because I know I'm going to look like a dope trying to find the images I need.
Only a health care provider charged with interpreting these pictures can understand the terror of having a patient look over your shoulder while you fumble around. The moments seem to turn into longer moments as I try to pull up the right pictures, the appropriate brightness or the proper directional view. Thank goodness many of my patients observe the sweat forming on my brow and offer to navigate the program for themselves; embarrassing, but appreciated.
Technology is indeed perplexing. Lately, a few of my younger patients have been wearing pedometers that seem to measure their entire life. The original, simple pedometer was designed to measure how many steps a person would take in a day. The new ones do that and also measure calories used and how many hours you have slept (no kidding). Some have a GPS thing going on and probably can post how often you floss your teeth on some social media site. I can applaud any technology that helps us be healthier, but this item makes me nervous. If it knows how long I sleep, does it know how much I snore?
As I peer into my flat screen, searching my electronic health records, I'm also listening to a replay of a radio broadcast on my MP3 player. Technology doesn't sleep. I know something new is coming. Will it make my life easier? So far, I am not convinced. I still have to push, pull, press, stretch, rub, goad, recoil or traction all my patients.
Unless technology brings me a clone of myself, I will continue to practice my primitive, hands-on craft, much like a potter making a clay pot on a pedal-driven wheel. In some ways that is reassuring to me. I know robots are now doing some types of surgery, but I don't want one adjusting my body – do you?
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