Lentis/Bedside Manner in the High-Tech Hospital

Introduction
Technology has permeated into the typical culture of hospitals in the United States. CT scans, MRIs, X-rays, ultrasounds, and more are utilized in commonplace hospital visits. Diagnostic exams aren’t the only place with increased technology, either; communication tools, RFID tracking of equipment, and portable monitoring devices have seen marked increases in recent years. All of the increases in technology have shifted the societal norms defining how a doctor should interact with their patient. This chapter aims to identify how the interactions between patients and doctors are changing because of technology, and how these changes may be perceived by participants in the hospital.

Traditional Bedside Manner
Bedside manner is defined as an attitude or approach a doctor takes with a patient, the doctor-patient relationship. Doctors are generally taught to be sympathetic towards their patients, receptive of their questions, and thorough in their explanations about their condition. However, this doesn’t necessarily take the forefront of any doctor’s mind as they enter an appointment. While a doctor may not be intentionally off-putting, the increased focus on shorter appointment times, entering more digital information, and running more diagnostic tests may not be well received by the patient.

Dr. Abraham Verghese
Dr. Abraham Verghese is a physician and author interested in preserving bedside manner and the traditional physical examination. In “A Doctor’s Touch,” a TED talk, Dr. Verghese expressed his views on changing bedside manner when he surmised, “I joke, but I only half joke, that if you come into one of our hospitals missing a limb, no one will believe you until they get a CAT scan, MRI, or orthopedic consult.”. In essence, he believes that technology has taken away some very basic skills of doctors to listen, observe, and physically examine a patient without the aid of technology.

Dr. Verghese believes in the importance of the bedside interaction to the doctor patient relationship. His traditional views stem from his values of empathy, compassion, and humanized experiences of healing. Tone, understanding of the patient, and eye contact can influence a patient’s experience in the clinic. Patients want a doctor they can trust; Dr. Vergehse aims to use traditional values to be that trustworthy doctor. His efforts to preserve traditional physical examinations manifests in the Stanford 25, an initiative aimed at ensuring doctors recognize the phenotypic expressions of disease through 25 fundamental, technique-dependent physical diagnosis skills.

Telepresence Robots
Telepresence robots are devices that stands 5 feet tall with a monitor as a head. These robots are mobile, and have sensors which keep the robot from bumping into objects. The use of telepresence robots increases access to medical specialists, especially in rural areas where there is a shortage of doctors. Regardless of the patient's location, the doctor can join them at their bedside in mere minutes. Doctors can visit extremely ill patients in intensive care units without unsettling the patient. Telepresence robots reduce the need for travel, and increase the amount of patients a single doctor can see.

Radio Frequency ID tags
Radio-frequency ID tags can track every doctor, nurse, and piece of equipment in the hospital to enable faster emergency response. This thorough monitoring allows hospitals to keep careful track of inventory and trends. In a Pittsburgh hospital, the ID tags register when someone walks in and shows on the patients’ screen who it is. RFID tags provide greater access to information about what happens within the hospital.

Smart Beds
Smart beds are being used to transmit patients’ breathing and heart rates to their charts. These smart beds also track if the patient is in bed or not. They serve as an alert system, allowing nurses to spot problems with patients, whether it be with vital signs or unauthorized movement from their bed.

Robotic Surgery
Robotic surgery allows a surgeon to see the surgical field onscreen as they sit at a console in the operating room, from which he guides the robot’s instruments. The robot’s hands are steadier than any surgeon's and have a wider range of motion than human hands. Additionally, the instruments are more flexible. Because the robotic surgeries are minimally invasive and more precise, patients experience less pain, decreased blood loss, faster recovery, and smaller scars.

Tablets
Doctors and nurses carry tablets with all the patients’ medical records as well as show them x-rays while sitting on the bed. A hospital in Chicago has taken this technology to allow children and patients in intensive care to play games and communicate to people in the hospital as well as family members outside of the hospital.

Injuries in Professional Sports
In some cases the doctor-patient relationship can be irrelevant or even detrimental to properly diagnosing a patient. The standard model for doctor-patient interactions goes something like this: the patient seeks the doctor’s input on a condition or ailment plaguing them. The patient tells the doctor everything that they have been experiencing; the doctor may run a few tests and then make a diagnosis. This paradigm serves the best interests of the patient because both the participants’ goals are to get the patient back to being as healthy as possible.

While that very well may be every patient’s goal as well, there are some cases where it may not be so simple. For example, doctors who treat professional sports athletes with injuries have very different relationships with their patients than typical doctors. Athletes want to return to playing as soon as possible. Athletes need to return to playing as soon as possible. The average retirement age of football players in the National Football League is only 28 years old, and injuries can bring about early retirements and changes in how players are paid.

So patients lie. “I feel great doc. Can I play now?”

This fundamentally changes the doctor-patient relationship. Doctors are still trying to get their patients back to being as healthy as possible, but the patients are also perhaps equally interested in being able to provide for themselves later in life when they are no longer able to keep playing.

Concussion in the NFL
In recent years, former NFL players have started developing neurological symptoms and diseases including Alzheimer’s disease and Chronic Traumatic Encephalopathy that have been attributed to head injuries and concussions sustained during their time as players. This August they reached a settlement in which the NFL will pay out 765 million dollars in medical care to thousands of former players.

What’s most worrisome about concussionsin doctor-patient relationships among athletes is that evaluations of the patient’s condition are based almost solely on how the patient feels. Some mental acuity tests like asking the patient questions and sometimes written tests are used but not with any degree of regularity. The treatment for concussion is simply lots of rest and slowly working back to higher intensity activities. Once the symptoms are gone, the patient is typically fine. This has possibly allowed players to take advantage of the doctor-patient relationship to return to playing earlier.

NFL Teams like the Philadelphia Eagles and Pittsburgh Steelers have recently begun using an immediate post-concussion assessment and cognitive testing system, or ImPACT, which is a computerized test developed by researchers in Pittsburgh which can determine if the patient actually has recovered entirely. It uses a standardized set of questions which factors in response time and accuracy to determine if the patient’s mental capabilities have returned to a normal level based upon the patients baseline results taken prior to the concussion. This has given doctors a new cheap objective tool with which to determine player’s conditions which is not reliant on the honesty of the patient.

Economic Burden
Hospitals are investing in high-tech bedside manners to improve clinical care and error rates, and reduce patient stress. In 2009, the amount spend on telemedicine was $2.4 billion and will nearly triple to $6.1 billion by 2012. Technology will give reason for citizens to stay away from hospitals. This was made possible by the economic stimulus package which set aside $19 billion for healthcare information technology. Future researchers could study a possible relationship between decreased financial burden and satisfaction in patients. Pressure from insurance companies and hospitals to reduce costs as much as possible could reduce the amount of care patients feel they receive, thus impacting the overall quality of care in hospitals.