Tuesday, July 31, 2007

The technology

Technology overwhelms me. By this I mean two things. One is that I find it intimidating. The other is that for all technology has given us, it has also taken something from us. Let me give you an example.

When I was a medical student twenty seven years ago there were three machines in the labor and delivery area that could be hooked up to a pregnant patient to listen to her baby's heart beat continuously and monitor uterine contractions. This machine is called an electronic fetal monitor. The hospital I am describing had at the time the busiest obstetrical unit in our country. There over fifteen thousand babies a year were assisted into this world by physicians, residents and medical students of Well Known College of Medicine. Today electronic fetal monitoring is the standard of care in all hospitals and is being used in most deliveries.

While in medical school, I delivered forty babies in the month I was on the obstetrical service and yet I cannot remember a single one of those patients being monitored electronically. I listened to the baby's heart beat with a fetoscope (A special stethoscope developed in the late 19th century.) or a fetal doppler (A newer invention borrowed from vascular surgery that amplifies the sound waves of blood flow through the baby's heart. The electronic monitor utilizes this technology.) that I held next to the mother's abdomen. I also had to put my hands on the mother's abdomen and feel the firmness of each contraction of the uterus while looking at the second hand on the clock to see how long the contraction lasted. Of course the mother could tell me how hard the contractions were and how long they were lasting. This conversation was another way that I "monitored" my patients in labor and I could monitor the patient's level of anxiety in the process. Frequently this conversation involved not only the patient but her support person(s) as well, filling in some of her social history.

Today, fetal monitoring is high tech and serves several good purposes including constant surveillance of the baby's heart rate and the mother's contractions. There are a number of companies that make fetal monitors competing in a high dollar market. Hospitals must have the latest system, not only for monitoring the labor of the mother and the well being of the baby but also for recording as a permanent part of the medical record a second by second account of what takes place while the patient is there.

This bit of technology reached new heights in the hospital where I practice a few years ago. The vice president in charge of nursing services presented our new system to the quality assurance committee. "This state of the art 'Name Brand Monitor System' will record every second of the laboring process, " she declared proudly. "And the nurses will be able to view it in the nurses' station, the conference room and the break room. They will be able to chart directly from any where there is a computer terminal." I could see the nurses would be spending less time at the bedside and more time in front of a computer screen. An added benefit would be the cost savings of allowing one nurse to take care of several patients. Much more cost effective, at least according to hospital administration, than the one on one nursing care the old way required. "The residents will be able to see what is happening in their call rooms," the nursing VP continued. Remembering my days as a resident the "call room" was a closet like room where you might grab a few minutes sleep between patients. "Doctors, you will have these screens in your office or at home if you choose," she beamed at us sitting back in her chair.

The vice president of nursing services was satisfied. We should all be relieved and reassured. Our hospital would have the most up to date equipment to care for our patients. Breaking the silence I facetiously said, "I always find it comforting when we have one more piece of equipment between the caregiver and the patient," I knew that this state of the art monitoring system was one reason that there would now be less face to face contact with the patient. Who needs to ask about or feel contractions? You can see them on the monitor. Who needs to put hands on the pregnant abdomen or listen directly to the fetal heart? The monitor is doing this for us. At least this is what the presenter wanted us to believe.

I some times joke, face to face of course, with patients, "I am waiting for is the transporter beam and we can skip the laboring process altogether. 'Beam the baby out, Scotty!' " And I will probably be able to do this from home.

My point is not just about the delivery of a baby. I am concerned here about the very technology I am using to write this post. I enjoy the Internet. I have fun finding and viewing different sites which is one of the reasons I began my own blog. I am addicted to email. I enjoy the contact that the Internet gives me with friends old and new, seen and unseen. There is a down side, however. When I spend more time staring at this screen, I am spending less time looking someone in the eye. Reading email is fine but being present listening to what a friend is saying, or not saying, is a far better use of time.

So, if your choice in the next moment is to read another of my posts or to turn and talk with a friend, hit the exit button. That post will be there when you return.
The technologySocialTwist Tell-a-Friend

No comments: