Breaking News
May 26, 2018 - CRISPR-Cas9-based strategy allows researchers to precisely alter hundreds of different genes
May 26, 2018 - UT Southwestern-led researchers find new way to determine prognosis of invasive kidney cancer
May 26, 2018 - Researchers develop film to prevent bacteria from growing on dental retainers and aligners
May 26, 2018 - Mobile health intervention for people with serious mental illness as effective as clinic-based treatment
May 26, 2018 - Vaginal estradiol tablets outperform moisturizers when treating vulvovaginal problems
May 26, 2018 - Researchers call for new genetic tests for congenital diseases
May 26, 2018 - KHN’s ‘What the Health?’ Campaign promises kept, plus ‘nerd reports’
May 26, 2018 - Lung-on-a-chip technology could streamline drug-testing for pulmonary fibrosis
May 26, 2018 - Study finds early antibiotic initiation for majority of premature infants
May 26, 2018 - New environmental monitoring project finds increased numbers of deer ticks in Southern Indiana
May 26, 2018 - Pediatricians Should Advocate for Life Support Training
May 26, 2018 - Cannabidiol significantly reduces seizures in patients with severe form of epilepsy
May 26, 2018 - Allergies can have serious, far-reaching consequences on adolescents
May 26, 2018 - Scientists develop lab-based system to study mechanisms of common liver disease
May 25, 2018 - New guidelines may help pathologists to more accurately classify and diagnose invasive melanoma
May 25, 2018 - Immune cells promote lung cancer metastases by forming clots in tumors, study finds
May 25, 2018 - Can Excess Weight in Toddlers Cause Brain Drain?
May 25, 2018 - Studying insight
May 25, 2018 - Researchers reveal potent new mechanism of action for treatment of IBD
May 25, 2018 - Study shows lack of follow-up care for patients with concussion
May 25, 2018 - Study establishes the importance of haploid cells
May 25, 2018 - Coveted BMJ award bestowed on The Clatterbridge Cancer Center
May 25, 2018 - AACN outlines evidence-based protocols and clinical strategies to manage alarms
May 25, 2018 - Origami inspires researchers to develop new solution for tissue regeneration
May 25, 2018 - Melorheostosis – Genetics Home Reference
May 25, 2018 - Non-addictive pain medication changing therapy for substance use disorders
May 25, 2018 - Delayed lactate measurements in sepsis patients increase risk of in-hospital death
May 25, 2018 - Researchers identify novel epigenetic mutations as cause of neurodevelopmental, congenital disorders
May 25, 2018 - UD researchers examine connection between DNA replication in HPV and cancer
May 25, 2018 - Researchers identify neurons that play key role in aggressive behavior
May 25, 2018 - Snail’s eye inspires new type of RIOCATH urinary catheter
May 25, 2018 - Russian researchers develop high-tech device-transformer for ultrasound examination
May 25, 2018 - Researchers discover unexpected chemosensor pathway for predator odor-evoked innate fear behaviors
May 25, 2018 - Researchers build 3-D printer that offers sweet solution to making detailed structures
May 25, 2018 - Nearly one in three people know someone addicted to opioids
May 25, 2018 - Research suggests link between faulty gene, alcohol, and heart failure
May 25, 2018 - New findings could help fine-tune treatment for cancer patients
May 25, 2018 - New cancer treatment approach targets specific sugar receptors
May 25, 2018 - Skin responsible for uptake of cancer-causing compounds during barbecuing than lungs
May 25, 2018 - Early-onset cannabis use linked to further drug abuse problems
May 25, 2018 - Covered California takes aim at hospital C-section rates
May 25, 2018 - FDA Approves Palynziq (pegvaliase-pqpz) for the Treatment of Adults with Phenylketonuria
May 25, 2018 - Arthritis Glossary
May 25, 2018 - Study links breast cancer to the body’s internal clock
May 25, 2018 - Strenuous exercise in teenage years may protect against height loss later in life
May 25, 2018 - FDA approves novel enzyme therapy for adults with rare and serious genetic disease
May 25, 2018 - New research project aims at developing effective interventions for kids with DLD
May 25, 2018 - Middlemen who save $$ on medicines — but maybe not for you
May 25, 2018 - Study sheds new light on sharp rise in fatal drug overdoses in recent years
May 25, 2018 - Students propose revision of listeriosis guidelines for safer pregnancy
May 25, 2018 - TNFi Exposure In Utero Does Not Up Serious Infection Risk
May 25, 2018 - Organization of cells in the inner ear enables the sense and sensitivity of hearing
May 25, 2018 - Yoga May Be Right Move Against Urinary Incontinence
May 25, 2018 - Drinking recommended amount of milk could protect obese children against metabolic syndrome
May 25, 2018 - New cytokine network can repair tissue damage in the intestine, study finds
May 25, 2018 - Lyme disease researcher dispels misconceptions about ticks and provides prevention tips
May 25, 2018 - Penn researchers find link between social media usage and underage drinking
May 25, 2018 - Unique nanotechnology method to simplify skin disease diagnosis
May 25, 2018 - Study reveals new protective mechanism for tumor cells in breast cancer
May 25, 2018 - FRAME Alternatives Laboratory chosen for major European liver research collaboration
May 25, 2018 - Study shows yogurt may dampen chronic inflammation linked to multiple diseases
May 25, 2018 - Invasive cancers that are born to be bad show detectable differences from harmless tumors
May 25, 2018 - Study identifies new mechanism involved in development of Lou Gehrig’s disease
May 25, 2018 - UAB professor receives award for malaria prevention study in pregnant women in Cameroon
May 25, 2018 - Study provides blueprint of how fruit flies can be used to screen potentially pathogenic human genes
May 25, 2018 - New drug-delivering nanoparticle could offer better way to treat brain tumors
May 25, 2018 - Kessler Foundation scientists compare two tests for assessing learning in individuals with MS
May 25, 2018 - Stroke Symptoms and Diagnosis (Beyond the Basics)
May 25, 2018 - Protein goes against the family to prevent cancer
May 25, 2018 - Drugmakers blamed for blocking generics have milked prices and cost U.S. billions
May 25, 2018 - Speakers announced for National Medicines Symposium 2018
May 25, 2018 - GSK Receives FDA Approval of Arnuity Ellipta for Asthma in Children From 5 Years of Age
May 25, 2018 - Pfizer settles kickback case related to copay assistance for $24m
May 25, 2018 - Nuclear pore functions are essential for T cell survival
May 25, 2018 - Study defines molecular basis to explain connection between mother’s nutrition and infant growth
May 24, 2018 - IHI hosts representatives to develop a national action plan for patient safety
May 24, 2018 - Zika detection breakthrough by University of Queensland
May 24, 2018 - FDA Alert: 95% Ethyl Alcohol Product by Ethanol Extraction: Recall
May 24, 2018 - New method allows scientists to study how HIV persists
May 24, 2018 - Study reveals rate of vertebral and non-vertebral fractures in children with leukemia
The Value of Human Touch

The Value of Human Touch

image_pdfDownload PDFimage_print

Addressing a two-headed monster of access and quality, representatives from our institution’s accountable care organization came to us with a proposal for a way to try to address a metric that we continue to do poorly on throughout the practices.

According to the data in their reports, across our institution our diabetic patients get annual screening for retinopathy done at a rate of approximately 30%. As you can imagine, this is well below the threshold that most organizations think is “best”, and is thus worth putting a lot of energy and effort into trying to improve.

When they presented this data to us, we had a lot of discussions about why the numbers are so low, and they listened to us when we said that many of our patients have ophthalmologists outside of the institution because of access issues, or fail to show up for the appointments within our own institution where we refer them most often.

When one of our patients goes to an “outside” eye doctor — and even in the best-case scenario, when we get a report back from them showing their findings — the information that this diabetic patient does not have retinopathy only makes it into the chart as a checkbox if we actively not only scan the report into the system, but we also go to the health maintenance tab in the electronic health record (EHR) and indicate the day that they had the screening done.

Due to these limitations, 70% of patients for whom the intervention is recommended don’t have the screening done, at least according to retrievable data from our EHR.

An Interesting Solution

The solution that has been proposed to overcome these issues, which they are already trying at several practices throughout our institution, is an interesting choice, a different way of looking at things, and it opens up a couple of cans of worms as we think about its implementation in our practice.

It turns out that one of our ophthalmologists has been working with a medical optics company and a large unnamed technology company to develop a freestanding retinal camera that can produce a complete 180° image of the back of the patient’s eye without the need for dilation.

Their plan is to introduce these cameras into every practice that manages diabetic patients, and offer to have every one of our diabetic patients sit down and get a picture taken of the back of their eye, which is then sent over to the ophthalmology clinic where they can analyze the image and screen for retinopathy without actually laying eyes or hands on the patient.

Apparently, where they’ve already tried using this, it’s been quite successful, and about 90% of patients had no findings that required anything further beyond those initial photographic screenings. A small percentage had diabetic retinopathy, and there were a few scattered incidental findings discovered as well that needed follow-up and ongoing care.

But what was missing here?

To me, it feels like this new technological process, while it may lead to 100% compliance with the guidelines, may in fact lead to a patient feeling like something was missing from their healthcare. Namely, an eye doctor.

Proceed With Caution

Notice I did not say ophthalmologist. While eye doctor and ophthalmologist are clearly synonymous, I use the word doctor to reinforce the sense that if each patient has an eye doctor taking care of them, someone who talks to them, carefully examines their eyes, sees the bigger picture while helping the patient see better, I think that’s better for patients than a remote camera and a highly trained technician sitting in the dark somewhere else reading screening images.

Now don’t get me wrong — for so many patients who screen negative, there’s probably not a lot of added value to actually spending all that time over at the ophthalmologist’s office, and for many patients access is an issue, the cost of the care is an issue, and the valuable use of that provider’s time is an issue. But I think as we began to expand the use of more and more technology to replace more and more tasks that have been an integral part of healthcare, we need to proceed with caution.

One of the stated goals of the companies behind this product, this high-tech camera, is to gather an enormous amount of data, scores and scores of images of retinas, to provide input to an artificial intelligence system that will ultimately allow a computer to read these screening images, without the input of a physician.

As technology becomes better and better, and we learn more effective and efficient ways to incorporate it into helping us take care of our patients, we will undoubtedly find ways to replace a lot of what we do with intelligent neural systems capable of doing some of what we’ve always done.

There’s value in that, but there is of course always a loss of some sense of who we are and what we do that goes with this.

The Virtue of the Physical

Many years ago, as a resident working in the critical care unit (CCU), we would admit patients overnight with a cardiology fellow, and then in the morning, with the sun rising outside, as a team we would present our findings and recommendations to the CCU attending who was on service with us that month.

I recall one early morning standing at the bedside of a sick elderly patient, who came in the night before with a heart failure exacerbation, was appropriately triaged and treated, and was now doing fairly well in the light of day.

As part of his plan, the fellow told the attending that he would like to get an echocardiogram on the patient that morning to assess the degree of his cardiac dysfunction.

I can still see how the attending gently guided the fellow and myself through a repeat history and physical examination, as we once again in an unhurried fashion laid our hands on the patient, and told the attending in words what we felt and heard and saw, where the jugular venous pressure was, where the cardiac point of maximal impulse was, what the delay in the distal pulses told us.

The attending finally turned to us and said, “So, what do you know?” It turns out we knew pretty much exactly what the echocardiogram was going to show.

I’m not suggesting we go back to the days where we relied solely on the history and physical, nothing in me wants to abandon the armamentarium of technology we already have, nor ignore the potential of technology momentum coming down the pike.

If this new camera provides information that helps me take better care of my diabetic patients, by knowing who desperately needs maximal interventions to get their diabetes under better control, then it’s all worth it at almost any cost. But I want to make sure that patient still has an eye doctor, still have someone looking at their eyes as part of their body, as part of them as a patient, and helps make sure they can always see their way through the world they need to navigate in.

Maybe eventually a great deal of what we do will be replaced by these computers, these robots, these devices full of neural networks and artificial intelligence.

X-rays and CT scans and MRIs will be read by machines. Cameras will scan every inch of our skin to pick up the precursors of malignant melanoma and other skin cancers.

But I hope we keep the doctors around, because I do believe that the care we provide is more than a brute analysis of data, or a crunching of numbers. This technology can help us, but I’m sure that it can never replace us.

At the end of the 1940 Disney movie “Pinocchio,” when he has attained his wish and shouts out, “I’m a real boy!”, he has achieved the humanity that he was unable to find despite having feelings, the capacity for thought, and the ability to propel himself forward.

He was, before that moment, wooden sticks and levers and hinges and wires controlled from above by strings, manipulated at the whim of others. And then he changed, becoming something more.

Technology will never be that; it will never be human. We owe it to our patients to always keep that in the care we provide them.

2017-12-21T16:13:04-0500

Tagged with:

About author

Related Articles