The Rise of Transaction Medicine

Today someone sent me a video link about new technologies that will change the way medicine is practiced, today, tomorrow, forever. All of these gadgets utilized smart mobile technology to monitor some aspect of physical health, including the “do it yourself ECG” app and the “monitor patients in the ICU” app. This link came on the heels of a number of similar videos I’ve been sent that look deep into the near future, where Bones McCoy’s tricorder is a reality and parents diagnose their children by pointing a tiny box at them. The wow factor is undeniable, the value and precision unprecedented; and yet, I find myself wondering, where’s the doctor? In over 15 years of studying medical interactions, I have seen a dramatic shift in the nature of the patient-provider relationship (it was already well under way in 1996, when I started my first hospital-based fieldwork), and the shift is unidirectional: doctors and patients know less about each other, and have a harder time connecting with each other, with each passing year.

As part of the field research division of a company that specializes in positive behavior change in the healthcare arena (for providers and patients alike), I have the privilege of a bird’s-eye view on various aspects of healthcare, from lots of points of view. The great thing about fieldwork is that it is the ultimate backstage pass. With this perspective, there are a number of things that appear to be driving the change from relational to transactional medicine, including the changing nature of the healthcare system, the growing number of therapeutic options and diagnostic markers that need to be discussed in an ever-shorter patient visit, and the rise of the purely slam-bam-vaccine-you-ma’am-walk-in-clinic, but one big, undeniable driver is the rise and ubiquity of medical technology.

The influx of medical technology is itself part of the larger trend of smart machines filling in everywhere for arguably less smart humans in jobs that apparently didn’t need people: ATMs have replaced bank tellers, surveillance equipment has replaced security guards, and there is now a whole generation of people who not only don’t understand what a telephone operator was, they can’t conceive of why we’d need one in the first place (“You see, there used to be these wires connecting the telephones, and someone would have to plug the wires in to the right… yes, wires, connecting telephones… wires… you’d tell someone who you were calling… I saw it in movies… Lilly Tomlin did this “ringy dingy” thing, it was funny… no, you couldn’t download Angry Birds…”). With all the focus on technology, on tracking and monitoring and testing and recording, it’s getting harder and harder to find people just talking (and if you’ve ever had a doctor speak with you while simultaneously filling in an EMR, you’ll know that technology is definitely becoming a barrier to human interaction). This absence of connectivity, or at least, the environmental pressures that are working against human connection, are detrimental—to medicine and to medical care, to patients, and to providers themselves, who can find themselves profoundly alienated from the people they treat.

I’m not in any way opposed to technological progress, and lord knows we need systems in place to track prescriptions, help patients engage, empower, self-monitor and stay compliant, and to aid general diagnostic precision. I do believe, however, that nothing will ever replace the doctor-patient relationship. We may not have one now, but we miss it. When all was said and done, the great thing about Bones’ tricorder is that it didn’t prevent him from talking to people, it freed him up to talk more. I just hope, in the next 15 years, we let the technology do the tracking, and the sensing, and the cross-referencing, but we let the people do the talking.

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