Humanistic Digital Medicine

I’m a fan of Abraham Verghese and his writing; however, I have to take issue with several of his comments in a recent (otherwise insightful) article in the NYT entitled “How tech can turn doctors into clerical workers.”  His main premise is that the electronic health record (EHR) and machine learning have not lived up to their potential for improvements in population health (probably true).  Instead, the EHR has become  a threat to basic clinical judgement and the cause of significant physician burnout.

.  ViviCam 6300

There is no doubt that completion of the EHR is a burden to many physicians.  The timely documentation of the physician-patient experience (and its accurate coding) seems more important than the interpersonal experience itself.  My colleagues in areas like general internal medicine and pediatrics refer to “pyjama time,” i.e. the two to three hours they spend at home, after their clinics, completing their medical records.  Thank goodness we’re pathologists!

One disturbing comment made by Verghese: “…as with any lab test, what AI will provide is at best a recommendation…that a physician using clinical judgement must decide how to apply.”  I must disagree.  A positive HIV test, for example, is more than a recommendation to treat the patient with antiviral drugs!  And of course the idea that the application of clinical judgement is the exclusive domain of the non-pathologist is absurd.  But this role in clinical judgement demands that pathologists continually educate themselves about clinical decision-making and therapeutic options.  (On the future role of AI in pathology, see my upcoming blog posts.)

What can pathologists learn from the EHR experience as we become more digital and more involved in machine learning?  Verghese states: “…the leading EHRs were never built with any understanding of the rituals of care or the user experience of physicians…”  We pathologists, particularly academic pathologists, must engage early with the developers of digital pathology interfaces (software, monitors, mice) to advise them about the user experience and ensure they enhance our abilities and don’t lead to frustrations and inefficiencies.

Another disparaging comment about pathology from Verghese:  “Caring is expressed in listening, in…the bedside exam, …not on a biopsy report.”  Some of the most caring and empathetic physicians I have ever known are pathologists.  That humanistic element of caring is an essential part of every good pathologist, and must be recognized if were are to become equal partners in the clinical care of our patients.

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