DOCTORS' LOUNGE
(continued from page 35)
much more so, the people.
The authors’ second goal is “transformative change.” What a
meaningless phrase. Did they not intend to say, “hugely expensive
experiment in valuing machines over people?” Or perhaps, “We
can’t change biology so we will call it patient noncompliance when
it fails?”
A third goal is “quality.” By this, they mean the Bots obediently
fill out every form required, so they can measure form-filling out and
proclaim 100% high marks. Meanwhile, the patients are checking
their blood pressures with machines, repeatedly, and jacking up
their meds as the Bot advises, until they fail to perfuse some vital
organ. How many hypotensive strokes do we need in this country?
How’s our demand/supply ratio for dialysis?
The authors care about “access and cost.” I would venture that
access depends on income, leaving out a large chunk of the pop-
ulation. It depends on smartphone access and savviness, and the
willingness to share personal medical information on a huge plat-
form that will never be perfectly impervious to hacking. Sure, Mr.
Bot, you can sell my data to all comers because I did not read the
57-page Terms of Agreement. And I promise to read every one of
the ads they send me, too.
Finally, I have had enough of this disrespect for general internal
medicine and family medicine. Bots, they toss off casually, can “deal
with” those common (implying simple) everyday problems of diabe-
tes, atherosclerosis and high blood pressure. Let’s just see these Bots
forge the close, trusting partnership that is required between patient
and doctor for both of us to walk the walk, and not just mouth the
words. We have not only to prevent as much misery as we can, but
we must intervene rapidly in acute illness and try to minimize the
damage. That means we have to see, know and follow the patient
throughout their life, and help them at the end.
You might one day untether me from the ventilator, but by God
do not untether me from my doctors. Can you imagine the horror
of “Botcare Does Hospice?”
Dr. Barry practices internal medicine with Norton Community Medical Associates-
Barret. She is a clinical associate professor at the University of Louisville School of
Medicine, Department of Medicine.
VOICES FROM THE PAST - IS ANYONE LISTENING?
AUTHOR John A. Lloyd, MD
“T
he lights of the stars that were
extinguished ages ago still
reach us. So it is with great
men who died centuries ago,
but still reach us with the ra-
diations of their personalities.”
(Kahlil Gibran, 1883-1931)
Kahlil Gibran, who was one of the patron
“saints” of the “flower generation” of the
1960’s, places a deserved value on the voices and actions of the past
greats, both men and women. To his “of their personalities,” one can
add “and of their wisdom.” To make an accounting of the legions
of voices from the past that have shaped the medical profession is
a daunting, if not impossible, task. But thanks to available internet
research, some examples of past voices that encourage thought,
and examples of those voices that have given valuable direction to
physicians, can now be recovered. If one listens, one can learn from
the past to the benefit of the present.
I can start with Hippocrates of Kos (c.460-c.370 BCE); many
credit him with the genesis of modern medicine. Hippocrates is
credited also with the instigation of the systematic study of clinical
medicine. He is thought to be one of the first, if not the first, to
believe that diseases are caused by natural phenomena and not by
superstition or gods (he separated medicine from the metaphysical).
He was notable for his insistence on strict professionalism, discipline
and honesty in the practice of medicine. Although attributed to
Hippocrates, the much cited “do no harm” dictum most likely had
its origin from the Hippocratic School founded on the teachings of
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LOUISVILLE MEDICINE
Hippocrates. In Epidemics, Book I, one finds: “Practice two things in
your dealing with disease - either help, or do not harm the patient.”
Following the worthy voice of Hippocrates comes the voice of Galen
(Aelius Galenas 130-210 CA) who was probably the Roman Empire’s
greatest physician. Galen developed a valuable guide for the practice
of medicine, in which he reminds the physician of the necessity of
understandable communication with patients. “The chief merit of
language is clearness, and we know that nothing detracts so much
from this as using unfamiliar terms.” Galen also reminds the prac-
titioner that “The physician is only nature’s assistant,” which is a
valuable admonishment for 21 st century physicians (a prescription
for helping to prevent burnout).
Listening to the ancient voices is an excellent place to embark,
but one can move closer to the present and still find wise counsel. In
Colonial America and extending through most of the 19 th century,
the physician was primarily a solo practitioner and had the stature
of being “one of the few.” With the advent of the 20 th century and
the expanding knowledge of disease, the exploding growth of tech-
nology, and the ever-expanding specialization, “the few” morphed
into a system of specialized health care and a multitude of allied
health professions. To address the issue, the American Medical
Association (AMA) published a booklet, The Physician’s Career,
in 1967, in which the expanded role of the physician is noted: “He
is involved in the training of aides and paramedical assistants, in
understanding of governmental programs at all levels and he must
still wrestle with the application of ethical concepts to the constantly
changing public environment. He is inevitably cast as a leader in
the organization of his particular community’s health resources.”