CORRESPONDENCE
Human Medicine versus
Techno-Medicine
To the Editor:
Dr. Herb Fred’s insightful editorial “The Downside of
Medical Progress: The Mourning of a Medical Dino-
saur”1 highlights several important dangers of overem-
phasis on technology and the changed thought patterns
of modern physicians in training and in practice. Dr.
Fred’s observations cannot be reduced to a mere myopic
“in the old days we walked through 10 feet of snow to
get to school” type of nostalgic sentimentalism. Rather,
what is described is modern medicine’s paradigm shift
in the way it views patients, and its drift away from the
human approach to the care of patients. Having fin-
ished medical school in 1984, I have seen only part of
the change, whereas Dr. Fred has seen it all. Although
it is generally true that at no previous time has medicine
been more able to effectively treat and cure complex dis-
ease, it is also generally true that at no previous point has
medicine been less respected by the population it serves.
How can this be? I completely agree with Dr. Fred that
there is a chasmal disconnection between the barrage
of technology with which the “techno-doc” assaults his
patients and the genuine hands-on touch and concern
that the truly humane doctor has for his patients. This
is not to view technology and authentic human concern
as mutually exclusive; appropriate concern for our pa-
tients often mandates the use of technology. But what
must not be forgotten is the obvious—simple kindness,
a gentle touch, a caring word—how hard is it, really?
Still, these simple attributes seem at times so elusive.
The key, of course, is that the physician must be con-
cerned for the patient as a human being.
On more than one occasion, each of us has seen pa-
tients who undergo a “million-dollar workup” via so-
phisticated radiology and other testing, followed by
high-tech surgery, yet they have neglected wounds or
decubitus ulcers that spiral out of control because of in-
competent wound care and lack of concern. The sim-
plest and most basic care would have sufficed to prevent
huge problems in these patients, who would have re-
ceived better care in the streets of Calcutta with the late
Mother Teresa. Mother Teresa once described a man
who died after she cleaned his wounds: “. . . There was
the man we picked up from the drain, half-eaten by
worms, and, after we had brought him to the home,
he only said, ‘I have lived like an animal in the street,
but I am going to die as an angel, loved and cared for’.”2
Surely, death in the loving arms of someone who real-
ly cares is far better than a cold, anonymous death in
an ICU. Viewing the human being as a person with an
268
eternal soul, rather than as an object of technology, is
what makes the difference.
While the growing influence of ever-more-sophisticat-
ed technology makes the human side of medicine seem
somewhat more distant, it is by no means unachievable,
as long as the focus remains on the patient as a human
being—not as an object on whom to try out new tech-
nologies in order to impress our colleagues. Far more
damaging than technology per se is the corrosive effect
on our profession from the general deterioration of so-
cial integrity, honesty, and morality over the past 4 dec-
ades. Just look at what has happened to the professions
of law, politics, and business. Although we in our pro-
fession should be immune, we cannot be, completely.
When we remain silent and look the other way at legal-
ized atrocities inflicted upon the youngest, oldest, and
most helpless of humanity—when we become callous
to the inherent dignity of human life from conception
until natural death—then we forfeit in some way, little
by little, the soul of our profession. In the recesses of our
hearts, we know it.
Furthermore, society’s obsession with financial ex-
cess and getting a free ride—ranging from playing the
lottery to filing spectacular lawsuits to entertainment
careers for “American Idol” rejects—doesn’t positive-
ly influence the attitudes of medical trainees and new
program graduates. Some trainees maintain a distress-
ing sense of entitlement regarding service, the feeling
of being owed an education (and a luxury car) while
avoiding hard work. I completely agree with Dr. Fred
that the 2003 Accreditation Council for Graduate Med-
ical Education work-hour limitations for residents “en-
courage laziness . . . disrupt continuity of patient care,”
and “create extra work for an already-overworked teach-
ing faculty who now must do what the ‘off-duty’ house
officers should be doing.”1 Indeed, I write this tonight
after having just gone back to the hospital to place a he-
modialysis catheter in a patient whose potassium level
was 6.7 mEq/dL. Line placement, it seems, is beyond
the scope of practice and is beneath the dignity of the
vascular fellow and the surgical resident. The procedure
may have helped to save the patient’s life, but it was
not high-tech enough to be “educationally worthwhile.”
How sad. At some point, doctors need to be just that:
real doctors. And it doesn’t get any easier after residen-
cy and fellowship. As a surgical resident in the 1980s
at Harbor–UCLA, I loved to go down to the ER to
admit nonsurgical patients who had cellulitis or deep-
vein thrombosis and whom Medicine did not want to
admit; the so-called “turfing” of patients was repulsive
to me and was an anathema to my concept of being a
real doctor. In fairness, of course, now as in every era,
Volume 36, Number 3, 2009
there are young physicians who attend to patients in ex-
emplary fashion—physicians whom I would choose to
treat members of my own family.
Modern medicine surely can treat disease better now
than was possible 40 years ago. However, modern med-
icine must also care for the patient as well as it did 40
years ago. We must never forget that spark of inspira-
tion that made us aspire to become physicians in the
first place.
Fritz Baumgartner, MD,
Clinical Assistant Professor of Surgery,
Vascular Surgery Associates,
Los Alamitos, California
Texas Heart Institute Journal
References
1. Fred HL. The downside of medical progress: the mourning of
a medical dinosaur. Tex Heart Inst J 2009;36(1):4-7.
2. Address of Mother Teresa of Calcutta at the National Prayer
Breakfast, Washington, DC, 1994 Feb 5 [cited 2009 May 9].
Available from: http://www.catholiceducation.org/articles/
abortion/ab0039.html
Letters to the Editor should be no longer than 2 double-spaced
typewritten pages and should contain no more than 6 referenc-
es. They should be signed, with the expectation that the letters
will be published if appropriate. The right to edit all correspond-
ence in accordance with Journal style is reserved by the editors.
269