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Physicians Should Learn How To Practice Medicine With And Without Technology

This past December (2008), there was a report in Healthcare IT (Information Technology) News that got me thinking, of all things, about medical situations in outdoor wilderness environments. The substance of the report was that researchers at Vanderbilt University (I worked there in the late ’80s as Chief of the Division of Emergency Medicine) “found that physicians who receive training in a technology-rich environment, but go on to work in a less modern facility feel they can’t provide safe, efficient care.”

The study related to information technology, but is probably applicable to many other modes of technology. As it was reported, the Vanderbilt study included more than 300 medical training graduates. Of those who “were working in an environment with less IT,” some 80 percent reported “feeling less able…to work efficiently, to share and communicate information, and to work effectively within the local system.” The lead investigator Kevin Johnson, MD explained that “going from being a medical student where somebody is always watching after you to a role where you could potentially make a mistake that could actually harm a patient is already hard enough.” But “when you get there and realize that the systems they have are less functional and less pervasive…there is an entirely new set of challenges.”

To all medical students, residency graduates, or anyone else who moves from a highly supervised environment to one where you are on your own, welcome to the club. The whole point of learning how to be self-sufficient is to be able to go it alone when the need arises. What is most striking about wilderness medicine is the notion that one moves to a setting that is austere and resources (people, technology, supplies, communication, etc.) are frequently limited. This can be very unsettling for experienced practitioners, and is even more so for neophytes.

We live in an age of technological imperative. Doctors train in hospitals with large, complex intensive care units. The emergency department is equipped with all the latest gadgets, and specialists are on call 24 by 7 to help out when a difficult or puzzling situation arises. That is not the case in the wilderness, on the battlefield, or out at sea. Expectations change from perfection to doing enough to get the patient to a higher level of care, or just to make it through the hour, let alone the next day.

Think about it. Take your favorite medical instrument(s) and think about how you would practice if you didn’t have access to it. Could you diagnose heart failure without a stethoscope and pulse oximeter? High altitude cerebral edema without a CT scan? Septic shock without a blood pressure monitor, central venous catheter, arterial blood gas measurements, and a battery of laboratory tests? I think the answer is “yes” if you were properly trained.

Technology is good. In fact, it is great. Patients are better off for the ability of health care professionals to apply all manner of diagnostic and interventional devices and techniques. However, I believe that at the same time we are all taught how to do things in the city, we should learn how we must sometimes do them in the country.

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This post, Physicians Should Learn How To Practice Medicine With And Without Technology, was originally published on by Paul Auerbach, M.D..

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