The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age
Robert Wachter
New York: McGraw-Hill Education, 2015
Modern medicine in the 21st century is an evolving enterprise of knowledge and 
technology. In The Digital Doctor, Dr. Robert Wachter, one of America’s 50 most influential physician- executives, discusses the wiring of the healthcare system in the form of electronic health records and ‘big data’ today. While there is hope digitised healthcare will increase the efficiency of practitioners and improve clinical practice, Wachter reports less than optimal experiences – interrupted work flows in the clinic to attend to electronic databases, decreased opportunities for the practitioner to establish healthy doctor-patient relationships, and occasionally, fatal consequences when the technology we so heavily rely on fails us. Indeed, Wachter succinctly summarises today’s epoch of computerised healthcare in his title – “hope, hype and harm.”
As a medical student, The Digital Doctor has been thought provoking. My generation of medical students are digital natives who, having grown up with technology, are comfortable with it. Yet, as Wachter points out in his book, by being too comfortable with computerised healthcare, we are less critical of its shortcomings. It is hence imperative to reflect on the importance of striking a balance between being technologically-competent and being vigilant in the age of digitised healthcare.
Through interviews with prominent health professionals and vivid anecdotes, the picture Wachter paints is realistic but solemn. When patient history, drug doses, and investigations are electronically recorded, bedside treatment shifts to the computer. Electronic health records and digital monitoring of the patient, which may come in the form of electronically updated investigation results, introduces the concept of the ‘iPatient’. The iPatient is monitored online, and only attended to when the electronic healthcare system sends out reminders. The fundamental concern is that less time is spent taking a history or physically examining the patient. The end result being that we might overlook diagnoses and unnecessarily invest in costly technological interventions. When these amount to hastened patient interactions and increased billing costs, the patient’s experience with the healthcare system will be an unsatisfactory one.
Digitised healthcare may have also fallen short of the areas in which it has sought to improve. Although digitised healthcare was designed for convenience, electronic documentation is burdensome when one must adhere to strict formatting when recording data. Additionally, the availability of patient information at the click of a mouse means that any data stored online is just as easily lost, possibly through software malfunction or accidental deletion. Furthermore, there is the possibility that digitised healthcare undermines the skill of practitioners, where practitioners are too trusting on the computer to speak up when in doubt. The Digital Doctor draws up a real incident whereby a computer error led to a teenager being prescribed an overdose of 38.5 antibiotic tablets. The error, despite raising suspicions amongst the nurses, was not corrected, and resulted in the patient taking the prescribed medication overdose. This raises the concern of the quality of education students receive to prepare them for transitioning to practitioners. Are we adequately trained to confidently apply our knowledge in real life situations where the patient is more than an illness defined by exam buzzwords? Is there the possibility that we give ourselves room for mistakes because we trust that computerised healthcare will always correct us when we are wrong? As current medical students undergoing traditional medical school teaching methods, are we sufficiently prepared to become future doctors competent both in our practice, and in the technology that accompanies it?
It is crucial to note that this narrative is set in America. While there are differences between the American and Australian healthcare system, we too practice digitised healthcare, and there are lessons to learn. We should accept that this technology is inevitable alongside advancements in diagnostic and therapeutic equipment. We need to understand that technology is an aid to improve our practice. It is not an alternative or a distraction. We must remember that it is still our patients we are treating, not digital data presented to us.
The Digital Doctor is a cautionary narrative that is highly relevant, albeit critical. We need to accept that the interface of medicine, as The Digital Doctor rightfully highlighted, is changing. The future of technology in healthcare is dynamic and promising – it can be our Mecca if we are adaptive practitioners in using this technology. While we are never fully prepared for what lies ahead of us in our medical careers, we are at the very least, enlightened by the age of computerised medicine and what it has in store for us, both good and bad.
Conflict of Interest
None declared.
References
[1] Wachter R. The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age. United States of America: McGraw- Hill Education; 2015.