Anyone here old enough to remember that turn of the phrase? It’s from the old ‘60s television series Lost in Space and was uttered by a robot named “Robot” while flailing its accordion arms anytime some alien menace approached young Will, played by child actor Billy Mummy. Not that it made any difference, as Will inevitably ignored the warning in the interest of ratings and adventure.
I find myself having the same reaction on a daily basis as I instruct emergency medicine residents on the diagnosis and treatment of all sorts of alien diseases. You see, I have been self-diagnosed as what I call “technologically disinterested,” accepting of the unavoidable presence of digital information but dubious as to whether it is friend or foe in the clinical setting.
I clearly remember back to the dark ages when X-rays were actual films slapped upward onto a lighted viewing box, just like in the malpractice ads on TV. Then, one wonderous day in the late 1980s, straight out of the comic book Weird Science, we were informed of the acquisition of a brand new machine in the hospital called a CAT SCAN. It was huge, noisy, and the patient had to lie in a coffin-sized enclosure for more than 45 minutes to produce a grainy photo looking more like the original moon landing than the inside of a human body. It was to be used only in very special circumstances, and we had to call the radiology attending at home to get permission for its use.
Well, as you know, things have changed drastically. Now if we don’t order a scan for even the slightest tummy ache, we run the risk of an unwinnable lawsuit if a diagnosis is missed. The same is true with ultrasound, and magnetic resonance imaging (MRI), and lactate levels, and troponins, and on and on. To compound the trend, academic literature has come up with countless acronyms of metric scoring we are supposed to follow to determine the presence, or absence, of a disease. The progenitors of this movement were the infamous Glasgow Coma and APGAR scores, each somewhat manageable in their own right. But soon followed the National Institutes of Health Stroke Score, PERC for pulmonary emboli, Well’s Criteria for the same, Modified Well’s Criteria, trauma injury score, HEART score for cardiac ischemia, Sepsis stratification, and on, and on, and on. There are now multiple apps to simply keep track of all of them.
I personally haven’t memorized any of these scoring tools. My cerebral cortex was filled to overflowing a couple of decades ago, and any new information wishing to get in has to displace some prior knowledge to make room. But the funny thing is, I don’t need to know them. Because out of necessity during my medically formative years, I had to learn to diagnose by actually talking to and examining a patient. No scans. No benchmarks. No metrics. Which at times puts my residents in a state of mild awe (how does he do that? The sentience score was 0, but somehow he knew the patient was still alive!)
I tell them it’s a gift. And it is—the gift of still relying on observation, human contact, and intuition rather than adding together a few numbers and believing that the sum actually reflects the reality of the situation. I know what a strep throat looks like. I recognize when someone is having an actual heart attack, even if the EKG is nondiagnostic. I can feel whether someone is truly suicidal, or simply begging for attention.
Actual patient contact is an arena where I’ve always envied the hands-on approach of the osteopaths and chiropractors (although I fear for the future of the DOs as they become assimilated by the allopathic health care system). And I would counsel the other formerly known as “CAM” professions to temper their hunger for evidence-based designation and research confirmation of what their progenitors have known to be true through observation and experience. Yes, evidence is necessary, especially in today’s managed care world, but it is not gospel. The majority of sexy research findings in the news today won’t survive confirmatory studies and will be forgotten within months, while holding someone’s hand as they suffer has never been proven obsolete.
So while my fellow smarter and more informed faculty peers instruct on what changes in the rate of CPR compressions or new epinephrine dosing might give a 0.5% greater chance of survival during a resuscitation in the code room, I quietly slip out to talk to the family waiting outside the door and then come back to inform the team that Grandma was adamant in life that she did not want any heroics in death, especially based on some recent research study.
As Robot used to say: “It does not compute.”
Biography
