Assembly Line Medicine
These are the cornerstones of western medicine.
When I recently entered my doctor’s office, I stood patiently in line, told the receptionist my name, confirmed my address, phone number, and insurance information. I then filled out pages of medical forms, clicked little boxes of my medical history, diagnoses, surgeries, allergies and medications. I was taken back, put on a scale to measure my weight and then my height, numbers quickly written down by the assistant on another piece of paper.
I entered the exam room, the assistant took my temperature, my blood pressure, then measured my pulse and oxygen saturation. She sat at the cold computer, opened my electronic chart, typed into boxes of all the data she had already collected. Information that is supposed to give clues as to my state of well-being. I was screened for depression by flat questions, asked how much alcohol I drink, how much tobacco I smoke and if I do any illicit drugs. My preferred pharmacy was confirmed, and then, finally, we got to the purpose of the visit.
“What brings you in to see the doctor today?”
There was a pressure to be as succinct as possible with my complaint. I knew there were other patients waiting in the nearby exam rooms, others out in the waiting room, others waiting on the phone lines, all with their own complaints that needed to be addressed.
“I’ve been wheezing for three weeks,” I replied as she typed it into the computer.
“Ok, the doctor will be right with you.”
With no clock in the room to measure the passing of time, an unknown number of minutes later, the doctor walks in and I tell her my story.
After a quick rundown of my symptoms, a few clarifying questions, a listen to my heart and lungs, the diagnosis is made. The doctor sits at the computer, clicks more boxes, orders a chest x-ray and some labs, then sends a prescription to the pharmacy with a click.
The visit is over.
I leave the office feeling relieved that I have an answer to why I have been wheezing and reassured that after some treatment I will feel better.
But there was also a strong sense of something missing...something immeasurable.
As a physician I understand the power of data. I know that in the practice of medicine we need objective information and accurate measurements in order to make correct diagnoses. I understand how important it is to have biomarkers, those measurable substances indicating the presence of a disease: blood pressure readings, hemoglobin levels, fasting glucose and lipids, or genetic markers in cancer. We need the findings on x-rays and CT scans, on MRIs and angiograms.
All of these measurable data assist us in making diagnoses, in deciding on appropriate treatment, with understanding prognoses for recovery and response to treatment. While biomarkers are crucial in the practice of data driven medicine, they also lack subjective descriptions of how a patient feels or functions. Patients are more than little boxes. Patients are more than these objective measurements.
What would it be like if my physician had the time and space to ask me more subjective questions such as: How was I really feeling that day? What was important to me we make sure to discuss in that visit? What was I worried about in terms of my current health and future goals? What did I think was happening in my body? How had my wheezing affected my ability to do what I wanted to do in everyday life? How had it affected my ability to fulfill my life roles? What was I hoping would be the result of this visit?
How much easier would it be to heal our patients and ourselves if we were not restrained by assembly line medicine? How much more would physicians enjoy their calling to be healers?