As usual, I find myself in a very odd situation. On one hand, I've seen and discussed ambitious projects within the synthetic world of Second Life, such as Play2Train. On another, I have seen my post on Where There is No Doctor being made freely available become one of the most popular pages on this site. As a former Navy Corpsman who did a lot of hands on patient care in hospital and field environments, I have a very sincere respect for the patients and the people who still take care of them. And on still another, I have close ties to medicine in the Caribbean and South America - relatives and friends in the medical profession.
And as someone who has been involved in medical/disaster handling (not management! no one manages disasters...), enough so to gain some obscure mention here and there, I have always been somewhere on the edge of medicine and technology - from repairing the pulse oximeter in the ED or doing emergency surgery on the ED coffee maker to giving the old 12 lead a well placed slap next to the power supply to get it going (mechanical recalibration) to developing a database to deal with the medical readiness of 2000 Marines.
There is a large gap in patient care, I think. When I meandered into , I was surprised that I had come in late on a discussion that had been started along the same lines but with data I had not considered before. For example, how the digital divide affects patient care. I'd thought about this in some ways, of course, and have thoughts on how some things could be better such as globally standardized medical records, along the lines of the mothballed MAHIN project. But still, there are limitations to technology.
Niko Karvounis presses a solid point home:
...My worries aren’t entirely speculative. Consider the case of Internet “weblining”, the use of information to exclude or include people from certain online advantages. In 2006, for example, the largest phone companies in Texas announced their plans to build fiber optic networks targeting only 5 percent of customers that can’t afford the $110 to $200 a month subscription fee—as opposed to 90 percent of “high value” neighborhoods. The implications are clear: more affluent Texans would have faster access to virtual medicine...
Of course, this is correct. And on a global scale, it should cause some discomfort to anyone who has taken an oath to look out for the well being of patients. I have seen donated equipment (picture on right from Guyana) sent to developing nations firsthand. I have seen brilliant doctors working with things I would have considered antique in the 1990s in this decade. And on a broader scale, the point made by Niko Karvounis becomes much more solid.
On one hand, I see a synthetic world's stabs at better medicine. On the other, I see the evisceration of the people who can't afford the costs of medicine through pharmaceutical companies (Consider Brazil and the WTO over HIV medications), through cost of equipment, and... through the fact that doctors and nurses in the developed world make salaries that lead to brain drain in the developing world.
Are we losing the focus on people in medicine? I hope not... but the empirical evidence is not something I can find. Do medical administrators take oaths to look out for patients? Does the IT department in a hospital take an oath to care for the wellbeing of the patients?
And why do we need such oaths anyways? Are we really so far removed from our own humanity to need them? One is forced to wonder.
Can a machine comfort the dying? Diagnose cancer and break news to the patient? Would you like an email when someone you know dies, or perhaps an RSS feed would be better? Can a computer tell a woman that she is pregnant, or that she cannot have children? Would a webcam really help improve the humanity in these experiences?
I hope you said no to those questions. If not, Thoreau was right. We have become the tools of our tools. And perhaps we also misunderstand the silence.
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