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Computing and the humanisation of medicine
EDITORIAL COMPUTING
AND THE HUMANISATION
OF MEDICINE
From its very onset, it was believed that computing would bring assistance to hard-pressed medical practice-and so, indeed, it has done, and will do so increasingly in the future. This is, of course, all to the good, and further growth of computing as an aid to medical practice is devoutly to be wished for. One may question, however, if, in the rush of making medical practice more efficient, an area of important need has not been overlooked. One of the real factors that determines the quality of medical care, especially in hospitals, is the drive towards ‘efficiency’. The cost of processing a single patient through the components of a health system has to be decreased no matter what. Unfortunately, one of the most prevalent methods for enhancing the system’s efficiency is to employ the patient as a working component who contributes his time, effort, and intelligence to increase the efficiency of the hospital. At the same time, his contribution does not appear as an item in cost accounting. Take, for example, some of the methods hospitals use to decrease the cost of services! In some instances, patients are queued before treatment centres and in others, services are queued before patients. In the first instance, long lines of sick people accumulate at focal points of medical services, such as diagnostic and therapy clinics. Who has ever needed an X-ray and does not recall standing in a draughty and cold corridor seeing death from pneumonia approaching nearer with every second? As the alternative, technicians obtain necessary samples from each patient in sequence. Again, all of us who have had pleasant memories of hospitals will recall the 5.00 am donation of blood, urine and other mostly unspeakable substances. The point to remember is that not only do these types of procedures deprive individuals of dignity at a time when they can least afford it, but they are also demeaning in many respects to those involved in allocating and directing the same services. Medical technicians and paramedical professionals are forced to apply the same techniques routinely to long lines of patients in ways that are intellectually and physically deadening, and they do not enter the process of patient care in any constructive or creative way. Many of these dehumanising practices could be alleviated through the use of internal hospital information networks. For instance, hospitals possessing such information networks could make schedules for patients, serve therapy units or services, make patient treatment schedules available for immediate display anywhere, thereby aiding personnel in directing and implementing services or in changing them as the patient responds or fails to respond to care. Patient queues 159
160
EDITORIAL
could be virtually eliminated. Perhaps more important, all the staff could be drawn on in the process of designing patient goals, evaluating progress, and adjusting procedures to suit individuals and their circumstances. Now that the design of hospital information system is flowering, it may be the proper time to turn to the problem of humanising the system, rather than making it more efficient.
(Received: 20 March, 1973)
T. D. STERLING, Simon Fraser University, Burnaby, 2, B.C. (Canada)
AND THE HUMANISATION
OF MEDICINE
From its very onset, it was believed that computing would bring assistance to hard-pressed medical practice-and so, indeed, it has done, and will do so increasingly in the future. This is, of course, all to the good, and further growth of computing as an aid to medical practice is devoutly to be wished for. One may question, however, if, in the rush of making medical practice more efficient, an area of important need has not been overlooked. One of the real factors that determines the quality of medical care, especially in hospitals, is the drive towards ‘efficiency’. The cost of processing a single patient through the components of a health system has to be decreased no matter what. Unfortunately, one of the most prevalent methods for enhancing the system’s efficiency is to employ the patient as a working component who contributes his time, effort, and intelligence to increase the efficiency of the hospital. At the same time, his contribution does not appear as an item in cost accounting. Take, for example, some of the methods hospitals use to decrease the cost of services! In some instances, patients are queued before treatment centres and in others, services are queued before patients. In the first instance, long lines of sick people accumulate at focal points of medical services, such as diagnostic and therapy clinics. Who has ever needed an X-ray and does not recall standing in a draughty and cold corridor seeing death from pneumonia approaching nearer with every second? As the alternative, technicians obtain necessary samples from each patient in sequence. Again, all of us who have had pleasant memories of hospitals will recall the 5.00 am donation of blood, urine and other mostly unspeakable substances. The point to remember is that not only do these types of procedures deprive individuals of dignity at a time when they can least afford it, but they are also demeaning in many respects to those involved in allocating and directing the same services. Medical technicians and paramedical professionals are forced to apply the same techniques routinely to long lines of patients in ways that are intellectually and physically deadening, and they do not enter the process of patient care in any constructive or creative way. Many of these dehumanising practices could be alleviated through the use of internal hospital information networks. For instance, hospitals possessing such information networks could make schedules for patients, serve therapy units or services, make patient treatment schedules available for immediate display anywhere, thereby aiding personnel in directing and implementing services or in changing them as the patient responds or fails to respond to care. Patient queues 159
160
EDITORIAL
could be virtually eliminated. Perhaps more important, all the staff could be drawn on in the process of designing patient goals, evaluating progress, and adjusting procedures to suit individuals and their circumstances. Now that the design of hospital information system is flowering, it may be the proper time to turn to the problem of humanising the system, rather than making it more efficient.
(Received: 20 March, 1973)
T. D. STERLING, Simon Fraser University, Burnaby, 2, B.C. (Canada)