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Does Technology Encourage Mediocrity?

The huge investment in health information technology including EHRs, Drug Information, and a multitude of other systems has taken place over decades, recently accelerating as the promise of a technology-supported healthcare system becomes more of a reality. Incentive and accompanying penalty programs have been enshrined under the HITECH Act as well as through other programs designed to encourage adoption of information technology by clinicians. When these programs started a number of years ago, a limited amount of quantitative evidence existed demonstrating that EHRs and related technologies improved quality of care. As our knowledge base grows, we are beginning to move beyond anecdotal examples to evidence of the benefits of sophisticated technologies such as CPOE or clinical decision support systems (if implemented and used correctly).

However, is there potentially a darker side to the adoption of information technology? Can clinicians maintain the art of medicine in a dominantly technology-based practice setting? Will we lose the the great diagnosticians who honed their skill over decades based on their knowledge but also great powers of observation as we implement EHRs and become dependent on the integrated tools to diagnose for us, make recommendations and warn us of impending clinical problems?

Earlier this week I read a blog article by Dr. Stuart Gitlow, acting president of the American Society of Addiction Medicine. In the article When Brilliance Revolutionizes Treatment, Gitlow explores the impact of Steve Jobs on Apple as a single brilliant brilliant decision maker and states:

“If we look at physicians the same way, and imagine that we all fall on a bell curve, you might think you want guidelines and protocols and teamwork, at least for the bottom half of the curve. But by applying them to everyone, you end up with regression to the mean that rules out brilliance. You’d have no one with terrible outcomes, but you’d have no one with amazing outcomes either. All physicians would be following the recipe, producing equal products of certain and specific quality.”

Whatever the formula, there are the leaders and the followers. However, with information technology completely woven into the fabric of care delivery, will we create an army of adequate, competent physicians, but limit excellence? The culprit may be standardization of processes, templates, clinical decision support applications, and knowledge tools. In the words of Aldous Huxley, “Hell isn’t merely paved with good intentions; it’s walled and roofed with them. Yes, and furnished too.”

What are your thoughts? How do we ensure that quality of care continually improves, and “good enough” does not become the safe but mediocre standard to which we aspire?

Comments:

3 responses to "Does Technology Encourage Mediocrity?"
  • September 15, 2012
    Arvind Cavale
    said:

    The answer is “yes” except for those who have already mastered the art of medicine before embarking on digitization. However, for those that learn the practice of medicine this way, the best outcome is mediocrity. I couldn’t have said it better that Dr. Gitlow.

  • September 25, 2012
    BobbyG
    said:

    Very interesting. On this topic,I would commend to everyone Lawrence and Lincoln Weeds’ excellent and fairly radical (but exhaustively reasoned and documented) book “Medicine in Denial.”

  • September 26, 2012
    Robert D. Lafsky
    said:

    Well, when Zhou Enlai was asked what he thought about the French revolution, he said it was too soon to tell. That jibe certainly applies to this question even if we were to freeze all techical and medical progress now–but at the point in time we can begin to answer this question the technology and knowledge base will have progressed several orders of magnitude. That said, are we talking about people who look excellent, people who say they’re excellent, or people who have data to prove they’re excellent? And to come up behind the question, some of those “excellent” people are real good at global accusatory statements using qualitative terms like “excellence” as intimidation tools.

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