ebook img

The Technological Imperative in Medicine: Proceedings of a Totts Gap colloquium held June 15–17, 1980 at Totts Gap Medical Research Laboratories, Bangor, Pennsylvania PDF

153 Pages·1981·7.503 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview The Technological Imperative in Medicine: Proceedings of a Totts Gap colloquium held June 15–17, 1980 at Totts Gap Medical Research Laboratories, Bangor, Pennsylvania

THE TECHNOLOGICAL IMPERATIVE IN MEDICINE THE TECHNOLOGICAL IMPERATIVE IN MEDICINE Edited by STEWART WOLF Director, Totts Gap Institute, Bangor, Pennsylvania, Vice-President, Medical Affairs, St. Luke's Hospital, Bethlehem, Pennsylvania, Professor of Medicine, Temple University, Philadelphia, Pennsylvania and BEATRICE BISHOP BERLE Former Assistant Clinical Professor of Medicine and Preventive Medicine, Cornell University Medical College, and Associate Professor of Clinical Medicine, New York University School of Medicine, New York, New York PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Main entry under title: The Technological imperative in medicine. "Proceedings of a Totts Gap colloquium held June 15-17, 1980 at Totts Gap Medical Research Laboratories, Bangor, Pennsylvania" - Verso t.p. Bibliography: p. Includes index. 1. Medical innovations-Social aspects-Congresses. 2. Medical innovations- Economic aspects-Congresses. I. Wolf, Stewart George, 1914- . II. Berle, Beatrice Bishop, 1902- RA418.5.M4T396 362.1 '042 81-17751 ISBN-13: 978-1-4684-4120-8 e-ISBN-13: 978-1-4684-4118-5 AACR2 001: 10.1007/978-1-4684-4118-5 Proceedings of a Totts Gap colloquium held June 15-17, 1980 at Totts Gap Medical Research Laboratories, Bangor, Pennsylvania © 1981 Plenum Press, New York Softcover reprint of the hardcover 15t edition 1 981 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher TOTTS GAP MEDICAL RESEARCH LABORATORIES, INC. OFFICERS, DIRECTORS, AND TRUSTEES Mark D. Altschule, M.D., President; Visiting Professor, Harvard Medical School; Con sultant, Francis A. Countway Library of Medicine, Boston, Massachusetts Beatrice B. Berle, M.D., Vice President; Former Assistant Clinical Professor of Medicine and Preventive Medicine, Cornell University Medical College, and Associate Professor of Clinical Medicine, New York University School of Medicine, New York, New York; Former Research Associate, Albert Einstein College of Medicine, New York Stewart Wolf, M.D .. Secretary; Vice President for Medical Affairs, St. Luke's Hospital, Bethlehem, Pennsylvania; Professor of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania Phylls B. Sheridan, Ed.D., Treasurer; Assistant to the Vice President for Medical Affairs, St. Luke's Hospital, Bethlehem, Pennsylvania; Former Administrator, Bureau of Applied Social Research, Columbia University, New York William B. Bean, M.D., Sir William Osler Professor of Medicine, University of Iowa, Iowa City, Iowa; Former Director, Institute for the Humanities in Medicine, University of Texas Medical Branch, Galveston, Texas Andre Cournand, M.D .. Professor Emeritus of Medicine, Special Lecturer, College of Physicians and Surgeons of Columbia University, New York George Giaquinto, President, Atlantic Apparel, Wind Gap, Pennsylvania; Former Mayor, Roseto, Pennsylvania Miss Helen Goodell, Research Associate Emeritus, Department of Neurology, Research Consultant Emeritus, Westchester Division, Cornell-New York Hospital Medical Center, New York and White Plains Mr. George Plush, Realtor, 8angor, Pennsylvania Mr. Albert Rosenfeld, Consultant on Future Programs, The National Foundation, New York; Former Science Editor, Saturday Review Sol Sherry, M.D., Professor and Chairman, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania Eliot Stellar, Ph.D., Professor of Psychology and former Provost, University of Pennsyl- vania, Philadelphia, Pennsylvania Mr. Richard Suck, Former President, St. Luke's Hospital, Bethlehem, Pennsylvania Mr. Oscar Swarth, President, D'San Corporation, New York Nicholas T. Werthessen, Bioscientist, Office of Naval Research; Senior Research Asso ciate, Brown University, Providence, Rhode Island. Joseph M. White, M.D., Executive Director for Medical Education, St. Paul's Hospital; Professor of Anesthesiology, University of Texas Southwestern Medical School, Dallas, Texas PREFACE This volume contains the edited proceedings of a Totts Gap Colloquium held June 15 to 17, 1980 at Totts Gap Medical Research Laboratories in Bangor, Pennsylvania under the sponsorship of three neighboring community hospitals in the Lehigh Valley; St. Luke's Hospital of Bethlehem, Easton Hospital of Easton and Muhlenberg Medical Center of Bethlehem. The objective of the meeting was to examine from several points of view the impact of rapidly proliferating technology on medical education, practice and research, on hospitals and on the community at large. The participants were selected not only for their diversity of experience and point of view, but also for ability to listen as well as to speak. They were asked to examine, in an informal analytical dialogue, the effects on the quality and cost of health care and health education brought about by increasing reliance on medical technology. A further aim was to explore various strategies through which might be devised an affordable way to benefit fully from technological advances without compromising human initiative or diminishing emphasis on clinical judgment and effective communication between doctor and patient. The participants included a medical student, seasoned practitioners and medical educators, young specialists, researchers, administrators and members of boards of trustees of community hospitals and laymen as follows: Dr. Robert Ackerman, Associate Professor of Radiology, Harvard Medical School and Director of the Carotid Evaluation and Cerebral Blood Flow Laboratories at Massachusetts General Hospital. Dr. Paul B. Beeson, Distinguished Physician, VA Hospital Seattle, Washington, formerly Nuffie1d Professor of Medicine Oxford University, England. vii viii PREFACE Dr. Stanley Joel Reiser, Associate Professor of the History of Medicine, Harvard University. Dr. Howard Spiro, Professor of Medicine at Yale University and Director of the Division of Gastroenterology. Dr. William A. Tisdale, Professor of Community Medicine, University of Vermont. Dr. Sankey V. Williams, Assistant Professor of Medicine and Associate Director, National Health Care Information Center, University of Pennsylvania. Other participants, viewing the issues from the perspective of the community, were: Dr. Mark D. Altschule Dr. James Regan Mr. Nicholas Balabkins Dr. William Reppert Dr. Edward Benz Dr. Charles Saunders Dr. Beatrice Berle Dr. Lee Serfass Dr. Andre Cournand Dr. Hilary Siebens Dr. Stephen Diamond Mr. George St. George Dr. George Donaghue Mr. Oscar Swarth Dr. David Feinberg Dr. Nicholas T. Werthessen Miss Helen Goodell Dr. Kenneth Wildrick Mr. Albert V. Moggio Dr. Stewart Wolf Mr. Donald Porter Background literature made available to the participants is listed at the end of the book following the bibliographic citations. We are grateful to Oscar Swarth who generously took charge of projection and recording, to Helen Goodell who assisted mightily in the process of editing and Joy Ann Lowe who dealt patiently with the manuscript through its many revisions. CONTENTS Chapter 1 LEARNING THE RATIONAL USE OF TECHNOLOGY IN MEDICINE ••••••..••••••••.•.•..•••••.• 1 Chapter 2 IMPACT OF TECHNOLOGY ON MEDICAL PRACTICE ••••• 35 Chapter 3 IMPACT OF TECHNOLOGY ON MEDICAL EDUCATION ••• , 55 Chapter 4 IMPACT OF TECHNOLOGY ON COMMUNITY HOSPITALS AND THEIR PATIENTS •••••••••••••.••••••.• 87 Chapter 5 ADAPTATION TO MEDICAL TECHNOLOGY--SHAPING THE FUTURE •••••••••.••.••••..••.•.••.•.•• 99 Chapter 6 MEETING THE CHALLENGE--SUMMARY & FORMULATION •• 125 REFERENCES •••••••••••••••••••••••••••••••••••••••• 137 BACKGROUND LITERATURE ••••••••••••••.•••••••••••••• 143 INDEX •••••••••.•.•.••••••••••.•..••••.••..•••.•..• 147 ix CHAPTER 1 LEARNING THE RATIONAL USE OF TECHNOLOGY IN MEDICINE DR. REISER: An accurate identification of the first application of technology to the diagnosis of disease would certainly elude the conscien- Historical Perspective tious historian. A conven- ient place to start, would be with the stethoscope introduced by the 19th century French physician, Laennec. Physical diagnosis in Laennec's time consisted mainly of visual examination of the patient: looking at the color of the skin, facial expression, posture, anything that the eye could convey about the problems of illness although centuries before, Hippocrates had suggested that the physician place his ear to the chest of the patient to inquire about the sounds within. One day in 1876 Laennec was called as consultant in the case of a young woman with possible heart disease. He found that the traditional methods of evaluating patients were inadequate· to the task at hand. Laennec had seen direct auscultation used occasionally by a couple of his colleagues, the less intellectual surgeons, but was reluctant to apply it in this case because the patient was a young woman. However, in one of those rare insights which suddenly occur in a flash and result in a great discovery, he thought of the fact that sounds passing through solid bodies become augmented. Quickly rolling some sheets of paper into a tube, he placed his ear to one end and the other to the chest of the patient. 2 CHAPTER 1 The heart sounds which emerged led him to think that by pursuing this mode of examination, he might learn new signs of heart and lung diseases and develop a new set of diagnostics. In discussing his discovery, like most innovators, Laennec was perhaps too enthusiastic about its prospects and too critical of the older evidence of illness. For the hundred years that preceded Laennec's discovery, history taking was viewed as the most important, even the ultimate, diagnostic tool. G.B. Morgagni, in his book, THE SEATS AND CAUSES OF DISEASES INVESTIGATED BY ANATOMY, published in 1761, urged the correlation of the patient's symptoms with the location and nature of lesions found at autopsy. Knowledge gained at the autopsy table enabled the physician to visualize the anatomical disorder from a careful analysis of the patient's symptoms. According to Laennec verbal testimony gave inferior evidence: the same symptoms were described by the patients having different diseases, and different symptoms were expressed by those wi th th.e same diseases. He argued that the doc tor's senses were superior to the testimony of the patient, that the doctor should listen to the patient through his ear but bypass the patient's mind. This was the fundamental change in the attitude of doctors toward diagnosis, to ignore the subjective evidence from the patient in the evaluation of his illness. This was the heyday of physical diagnosis and also of individualism in medicine. Doctors were trained in the use of their own senses, trained to believe that they could depend only on themselves as diagnosticians. Just as they had decreased their reliance on the patient, in many ways they did the same to colleagues. We all know that the sounds heard through a stethoscope placed on the same spot may be interpreted differently by different listeners. Alvan R. Feinstein in his masterly treatise CLINICAL JUDGMENT (1967) shows how difficult it is to compare that sort of clinical evidence. (1). The 20th century has created an entirely new set of diagnostics, which developed along side those of physical diagnosis in the 19th century. This is the whole armory of material which we refer to as laboratory diagnosis. It encompasses the automated analyzer of the laboratory, the x-ray, the electrocardiograph and other machines that essentially produce numerical and graphic data. These forms of evidence have taken precedence in the 20th century over

See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.