The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age
Format: PDF / Kindle (mobi) / ePub
The New York Times Science Bestseller from Robert Wachter, Modern Healthcare’s #1 Most Influential Physician-Executive in the US
While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare’s ills.
But medicine stubbornly resisted computerization – until now. Over the past five years, thanks largely to billions of dollars in federal incentives, healthcare has finally gone digital.
Yet once clinicians started using computers to actually deliver care, it dawned on them that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America’s leading hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point?
Logically enough, we’ve pinned the problems on clunky software, flawed implementations, absurd regulations, and bad karma. It was all of those things, but it was also something far more complicated. And far more interesting . . .
Written with a rare combination of compelling stories and hard-hitting analysis by one of the nation’s most thoughtful physicians, The Digital Doctor examines healthcare at the dawn of its computer age. It tackles the hard questions, from how technology is changing care at the bedside to whether government intervention has been useful or destructive. And it does so with clarity, insight, humor, and compassion. Ultimately, it is a hopeful story.
"We need to recognize that computers in healthcare don’t simply replace my doctor’s scrawl with Helvetica 12," writes the author Dr. Robert Wachter. "Instead, they transform the work, the people who do it, and their relationships with each other and with patients. . . . Sure, we should have thought of this sooner. But it’s not too late to get it right."
This riveting book offers the prescription for getting it right, making it essential reading for everyone – patient and provider alike – who cares about our healthcare system.
two. Here, the goal is nine, but extremities count as only one—no extra credit for listing the arms and legs separately.) This would be fine if all this mumbo-jumbo made a difference in the care of the patient, but it rarely does. Wachter 01.indd 38 2/12/15 12:43 PM Strangers at the Bedside 39 It certainly does, however, make a difference in the way we write our notes, and I have a natural experiment to prove it. In contrast to the way internists like me are paid, surgeons are
world, we’re learning, computers make some things better, some things worse, and they change everything. Harvard psychiatrist and leadership guru Ronald Heifetz has described two types of problems: technical and adaptive. Technical problems can be solved with new tools, new practices, and conventional leadership. Baking a cake is a technical problem: follow the recipe and the results are likely to be fine. Heifetz contrasts technical problems with adaptive ones: problems that require people
inflammatory disease of muscles), and microscopic polyangiitis (an inflammatory disease of blood vessels). One of the 10, compartment syndrome, was accompanied by a little red flag, since it is a “Don’t Miss” disease. Isabel is right: in compartment syndrome, there is something compressing the nerves in the arm, which must be freed up surgically before permanent nerve damage sets in. Wachter 02.indd 109 2/12/15 12:44 PM 110 THE DIGITAL DOCTOR Looking at the 10 diagnoses, I thought, “That’s
urgent, meant to alert nurses to a dangerously slow or fast heart rate, abnormal heart rhythm, or low blood oxygen level. But on this morning . . . infants and preschoolers activated red alarms by eating, burping, and cutting and pasting paper for an arts and crafts project. u u u In the face of growing nationwide concern about alert fatigue, Barbara Drew set out to quantify the magnitude of the problem. For a full month in early 2013, she and her colleagues electronically tapped into the
interruption. To make our healthcare system work, we need new models of care and new ways of managing our technology. The Digital Doctor brings us much closer to making this happen, which is why I finished the book far more optimistic than I was when I began it. It is a must read for everyone—patients, clinicians, technology designers, and policy makers.” —Maureen Bisognano President and CEO, Institute for Healthcare Improvement (IHI) “An engaging, accessible, and terribly important book by one