By Pat Sherman
Are advances in medical technology creating a depersonalized health care industry that is both a physical and financial detriment to patients?
It’s a question some 600 medical professionals pondered during Scripps Health’s fifth annual Quality Summit on March 9, titled “Caring for the Patient: from Genome to Bedside.”
The symposium, held at the Marriott Del Mar hotel, included a keynote address by
New York Times
best-selling author and physician, Dr. Abraham Verghese.
During his remarks, Verghese addressed what he sees as a gradual deterioration of the patient-physician relationship in lieu of costly diagnostic testing.
“We are entering a magical era in technology, but parallel to that comes the sense that there’s also jeopardy,” said Verghese, a professor of medicine at Stanford University.
Rounds — bedside visits by physicians or other medical professionals — are not taking place the way they once did, he said.
“Rounds seem to center around the virtual construct of the patient in the computer, something that I’ve coined the ‘iPatient,’ ” he said. “The iPatient is getting wonderful care all across America. The real patient often wonders where the hell everyone is who’s going to tell them what’s going on.”
Instead of thoroughly listening to what a patient is saying about their condition, Verghese said the average American physician interrupts them within the first 14 seconds.
The value of the physical exam — a ritual between doctor and patient that establishes trust — should not be underestimated, he said.
“As we’ve gone with increased diagnostic testing, it has been accompanied by a lack of faith and by oversight in the bedside diagnosis,” Verghese said. “I love technology, but I don’t see any need to abandon things that give you the diagnosis right away — and I think that if you’re good at the bedside you’re more likely to be parsimonious about what tests you order and spare the patient expense.”
During a panel discussion, Scripps Health’s corporate legal counsel, Richard Sheridan, asked how physicians can find the time — and healthcare systems justify the expense — of a 45-minute physical exam.
“When we have so many ways of wasting money, how is a 45-minute exam that saves you money and stops the patient from bouncing around healthcare systems a waste of money?” Verghese questioned. “I very often see this in our hospital where someone has belly pain and the house staff are about to go off shift and sometimes their instinct is to order a test, instead of going to see the patient.
“Going to see the patient might take a little more time,” he said, “but you might find that the pain is actually not in the belly or that there is some obvious explanation,” he said.
Dr. Eric Topol, chief academic officer for Scripps Health and a professor of translational genomics at Scripps Research Institute, championed recent breakthroughs in medical technology that can enhance the physical examination. However, he said, some rituals are “not always good.”
“I haven’t used a stethoscope in two years and I wouldn’t even try to teach a resident or medical student (to use one) when listening to heart sounds,” he said.
Instead, Topol uses a high-resolution ultrasound device that fits in his pocket and can be used to show the patient his or her heartbeat in real time.
“It’s an intimate experience because they’re looking at their heart beating and … the different dimensions of the chambers of the heart,” he said.
Instead of taking a patient’s pulse by holding their wrist, Topol uses a device that attaches to his iPhone like a case — something he used during a nonstop flight to diagnose a patient who was having a heart attack.
“By being able to do a cardiogram from a smartphone, we were able to make a diagnosis (that) led to an emergency landing,” he said, going on to tout a smartphone-operated glucose sensor and a device introduced by Carlsbad-based Life Technologies this year that can sequence a person’s DNA in two hours.
“A little more than a week ago, another technology using nanopores came out where it can actually fit into a USB-sized device and sequence a whole genome in minutes,” he said. “We’re coming to a point when genome sequencing is going to become so fast, so affordable and integrated into the future of health care.”
Verghese said he was hopeful that the genomic era would soon pay off — though he doesn’t feel it’s reached its full potential.
“When a patient walks into my office and he’s a male, he’s overweight and I see the outline of a cigarette packet in his shirt pocket, I feel I already know much more about him than Eric can tell me from his genome,” Verghese said. “The challenge is that the genome has to catch up.”